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DIRECTORATE OF LABORATORY MEDICINE
LABORATORY HANDBOOK
1. Foreword
2. Lead Clinicians
3. Normal working hours
4. Contacting the laboratory out of normal hours
5. Request forms and samples
6. Ordering Consumables
7. Hospital phlebotomy service
8. High Risk/Danger of Infection Samples
9. Storage of Samples Before Analysis
10. Clinical Biochemistry
11. Haematology and Blood Transfusion
12. Transfusion
13. Immunology
14. Microbiology
15. Virology
16. Infection Control Team
17. Histopathology
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Foreword
Quality is a strategic goal that delivers the best outcome for both clinician and patient. Laboratory Medicine has a primary commitment to quality which clearly
requires a close partnership between the providers and users of this service. We are committed to achieving and maintaining the highest possible standards. I
am sure that the information contained in this handbook will prove invaluable in helping us to attain this goal.
Dr Neil Todd
Consultant Microbiologist
Clinical Director
Directorate of Laboratory Medicine
Quality Assured
York is a CPA accredited Laboratory. Accreditation awarded by CPA (UK) Ltd is the result of a successful external inspection. This is a formal audit that
assesses the ability of the Laboratory to provide services to the highest quality. Laboratories holding CPA accreditation offer their users the reassurance of
clearly defined standards. We provide a comprehensive consultative and diagnostic service in collaboration with all users throughout the York Hospitals NHS
Trust and beyond.
CPA inspection occurs regularly and all departments are fully accredited.
Laboratory Location
The Laboratory Medicine Department reception is located on the ground floor at York Hospital with the departments on the first, second and third floors above.
Our address is:
Laboratory Medicine Department,
York Hospital
Wigginton Road
YORK
YO31 8HE
The Laboratory Medicine Department is the block to the right of the main hospital entrance and on the three floors above “Pharmacy” shown on the hospital plan
below.
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Directorate of Laboratory Medicine:
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YORK TEACHING HOSPITAL NHS FOUNDATION TRUST DIRECTORATE OF LABORATORY MEDICINE
Clinical Director
Dr Neil Todd
Consultant Microbiologist
Telephone (01904) 725216
LEAD CLINICIANS
Clinical Biochemistry
Alison Jones
Consultant Clinical Biochemist
Telephone (01904) 725786
Laboratory Haematology
Dr M Howard
Consultant Haematologist
Secretary Telephone (01904) 725854
Clinical Haematology
Dr L Munro
Consultant Haematologist
Secretary Telephone (01904) 725777
Histology
Dr C Bratten
Consultant Histopathologist
Secretary Telephone (01904) 725776
Microbiology
Dr D Hamilton
Consultant Microbiologist
Secretary Telephone (01904) 726170
Directorate Manager
Mr Paul Sudworth
Secretary Telephone (01904) 725859
Directorate Secretary
Mrs Cathy McSkeane
Telephone (01904) 725852
Finance Manager
Mr Paul Roth
(01904) 726190
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General Information and normal working hours
Clinical Biochemistry
8.30 am - 5.30 pm Monday - Friday
Haematology & Blood Transfusion
8.30 am - 5.30 pm Monday - Friday
Immunology
8.30 am – 5.00 pm Monday to Friday
Microbiology
8.30 am - 5.00 pm Monday - Saturday
Histopathology
8.30 am - 5.00 pm Monday – Friday
(last receipt of semen samples for Cytology 3.00pm)
Laboratory Reception
8.30 am - 5.00 pm Monday – Friday
Point of Care Testing (POCT)
8.45 am – 1715 Monday – Friday
The laboratory provides emergency services on site out of normal working hours for Haematology and Clinical Biochemistry and via an on call service for
Microbiology.
CONTACTING THE LABORATORY OUTSIDE NORMAL WORKING HOURS
Department
Bleep Number
Clinical Biochemistry
Haematology
Microbiology
Point of Care Testing
934
842
Dial switchboard '0’
01904 725890 and leave voicemail for action next working day
Point of Care Co-ordinator: Anne Penrice
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PATHOLOGY REPORTS
These are delivered to the wards by the portering service. The first delivery is at 11.30 am, the second at 3.30 pm and the third between 5 and 5.30 pm. Results
from samples tested in York are available to view on the ICE system and in Pathview on CPD.
REQUEST FORMS AND SAMPLES
Where insufficient details are provided on the request form and sample, the assay of the sample may be severely delayed or completely rejected.
Requests being made by the Ordercomms system will automatically have the correct data included if the procedure for using Ordercomms has been followed.
For full details on identifying samples and completing request forms please see:
Completing Request Forms and Labelling Samples Policy.
This document is available on Staff Room - Policies and Procedures › Clinical Documents › Laboratory Medicine - Completing Request Forms and Labelling
Samples Policy
SAMPLES
For samples (other than those for Blood Transfusion), to be acceptable, they must be labelled with
1) The surname
2) The forename
3) A third identifier; this can be…
(i)
The NHS number preferably
(ii)
The date of birth
(iii)
The hospital number, (or maternity ‘D’ number or A/E number) if there is no alternative.
Identifiers must be correctly spelt and complete, i.e. Initials are insufficient, as is an age of patient or just a year of birth.
Samples for Blood Transfusion must have four parameters for identification and one of these must be unique.
The sample must be labelled with
1. The surname
2. The forename
3. The date of birth
4. A unique reference; this can be…
a. The NHS number preferably
b. A Nuffield ID number
c. The hospital number, (or maternity ‘D’ number or A/E number) if there is no alternative.
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Identifiers must be correctly spelt and complete, i.e. Initials are insufficient, as is an age of patient or just a year of birth.
Samples for blood transfusion must be signed by the person taking the blood.
If a patient is unidentified then the A/E number must be used, the surname must be given as UNKNOWN and the gender of the patient entered in the forename
box.
Unlabelled samples are unfortunately not suitable for processing and will be discarded with the exception of Histology tissue samples. Unlabelled
tissue samples for Histology will be verified by the clinician attending the laboratory.
REQUEST FORM
The request form must have the NHS number, surname, and forename.
In addition to this, other details are required to ensure that a correctly interpreted result is delivered to the correct location.
Patient’s current location
Patient’s Date of Birth
Patient’s gender
Patient’s address
Consultant/GP
Time and date of sample
Clinical details
Drug history
Type and site of specimen, (as appropriate)
Dose and Time of last dose for drug assays
Referring clinician and contact details (especially important for ALL Immunology Specimens)
Antibiotic history (vital as part of any microbiology request)
The name of the requestor, who should normally be medical, must be provided to satisfy requirements for consent to test. This is particularly
important for sensitive tests such as HIV, syphilis, chlamydia etc.
All requests for cervical cytology should be accompanied by the special (HMR 101/5) forms and all details must be completed with the full patient address,
NHS number, and sender details along with the smear takers unique LBC smear taker code.
All samples should be dispatched to the laboratory as soon as possible after collection to ensure best turnaround times and most accurate results. It is highly
recommended blood samples should arrive in the laboratory within 24 hours of collection – the laboratory may not be able to process samples received after this
time. Overnight storage of blood samples before dispatch to the laboratory is not recommended and actively discouraged. Contact the laboratory for further
details.
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TRANSPORTATION OF SAMPLES AND POSTAGE
All users are referred to the current laboratory document. This can be found on the Trust Intranet - Staff Room: Policies and Procedures › Clinical Documents ›
Laboratory Medicine. A hard copy of this policy is available on request.
ORDERING CONSUMABLES
There is a form for ordering consumables from Pathology Reception. This form can be sent into the laboratory or faxed to 01904 726358. Please order weekly
and try not to keep large stocks of consumables as some items deteriorate with time.
M:\HANDBOOK\
LM-TEM-GENORDFRM.doc
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PHLEBOTOMY (BLOOD TAKING) SERVICE
Key Contacts
Catherine McCluskey, Phlebotomy Manager
Jo Peirson & Stephanie Holt, Senior Phlebotomists
Blood taking - OPD
Blood Taking – Wards
Service Location and Times
Telephone
6544
6544
6544
Wireless Telephone
1088, 1089 & 1090
Location
Times
York Hospital OPD
(Walk In Service)
York Hospital Anti-coag Clinic
(Walk In Service)
York Hospital Haematology Clinic
(Appointment Only)
ASDA Monks Cross
(Walk In Service)
Sherburn in Elmet Health Centre
(Appointment Only)
Selby War Memorial Hospital OPD
(Appointment Only)
Tadcaster Medical Centre
(Appointment Only)
York Hospital Ward Visits*
Mon – Fri 08:00 – 17:15hrs
Mon – Fri 08:00 – 11:00hrs
Mon – Thurs 13:15 – 16:30hrs
Wed & Fri 09:15 – 11:30hrs
Mon –Thurs 08:30 – 16:40hrs (closed for lunch 13:00 to 13:30)
Fri 08:30 – 15:00hrs (closed for lunch 12:00 to 12:30)
Mon, Wed & Fri 08:15 – 11:30
Mon – Thu 08:30 – 16:30hrs
Fri 08:30 – 12:30
Mon – Fri 08:15 – 12:15hrs
Mon – Fri 08:30 – 12:30hrs
*Blood taking on the Wards occurs between 8.30 am and 12.30 pm Monday to Friday and between 8.30 am and 12:30 midday Saturday and Sunday. Wards are
assigned time slots during these periods to enable equitable distribution of phlebotomist’s time.
Patients admitted in the afternoon for ‘cold surgery’ or for investigations should be asked to attend outpatient blood taking before changing into their bedclothes.
A weekend service exists for all Bank Holidays except Christmas Day.
Requests generated by Ward Ordercomms must be ticked as “Specialist Collection” if phlebotomists are required to take the samples and should be in place by
08:30. Please note that the phlebotomists will not normally return to your ward.
Please note the following
Urgent specimens should be taken by the doctor and sent immediately to the laboratory. The laboratory must be informed by telephone of the imminent arrival of
an urgent sample. Samples marked “urgent” for which there has been no warning telephone call will be treated as routine.
Blood cultures will usually need to be taken by ward based staff as the timing will be determined by the condition of the patient.
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High Risk/Danger of Infection Samples.
High Risk Samples
Samples must be considered High Risk if the patient has, or is suspected of having…
CJDv
HepB
HepC
HIV
Or any other disease classed as category 3 or above.
TB
Samples from patients with jaundice of unknown origin and patients known to engage in high risk activities, such as IV drug abuse, must also be considered high
risk.
Packaging and Transport of High Risk Samples
All samples that are included in the above categories must be double bagged and must NOT be transported using the vacuum tube system.
Labelling Samples as High Risk.
There is an absolute requirement that high risk samples are labelled as such before transport to the laboratory.
The mode of labelling differs with the type of request.
1) Requests made by Ordercomms electronic requesting.
The High Risk box must be ticked when making the request on Ordercomms. This ensures a subtle format change to the request form which, along with the
use of double bagging, provides all the labelling required.
2) Requests made to Microbiology.
For all high risk samples the high risk box on the Microbiology request form must be ticked. Remember to complete the Microbiology request form with all
patient details as usual. The sample should be double bagged by placing it inside a second Microbiology request form bag.
3) Other requests.
Requests for departments other than Microbiology, (and where no Ordercomms requesting is available), must clearly indicate the infection risk of the patient
on the request card. The sample should be double bagged by placing it inside a second request form bag.
Any queries regarding high risk samples can be addressed to
Dr D Hamilton
Consultant Microbiologist
Department of Microbiology
York Hospital
Mr. Paul Sudworth
Directorate Manager
Laboratory Medicine
York Hospital
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Blood from these patients should normally be taken by medical staff. If Phlebotomists are asked to take blood they must be informed of the situation. This is the
personal responsibility of the doctor making the request.
If Phlebotomists are asked to take blood from patients being barrier nursed they must be informed of the situation.
Storage of Samples before Analysis
All samples will deteriorate from the time they are collected but, with a few simple measures, this deterioration can be minimised.
Samples collected in the hospital should be transported to the laboratory as soon as possible. For some tests special collection procedures should be followed.
Please check the tables of sample requirements elsewhere in this handbook to see if special collection procedures apply.
Samples collected outside the hospital should be stored at room temperature until picked up for transport to the hospital. If samples are collected after the
transport has left then they should be placed in a refrigerator except those samples for genetic tests (EDTA), HLA B27 (EDTA), joint aspirates or other “sterile
fluids”, urethral swabs and HVS.
It is best to avoid collecting samples for urea and electrolytes, magnesium, phosphate, ESR, coagulation studies, malarial parasites, cold agglutinins and viral
PCR if they cannot be transported to the hospital that day. Arrange for the patient to attend at another time when the samples can be sent to the hospital on the
transport later that day. Alternatively the patient can attend the walk in phlebotomy service at York Hospital or Asda at Monks Cross. Opening times for these
services are detailed in the Phlebotomy Service section of this handbook.
Some surgeries have centrifuges to spin down brown top blood samples. Once spun down, these samples are relatively stable but may be stored in a
refrigerator until collected by transport. Please clearly mark the request card that the sample has been centrifuged and also put a blue cap onto the tube to show
that it should not be centrifuged again.
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CLINICAL BIOCHEMISTRY DEPARTMENT
1.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Blood gases and ionised calcium
Test requesting
24h urine collections
eGFR
Therapeutic drug monitoring
Screening for drugs of abuse
Lipid analysis
Fasting times
Sampling protocol for plasma metadrenalines
Dynamic function tests
Pregnancy tests
Hypoglycaemia in children
CSF sampling for suspected subarachnoid haemorrhage
Pleural fluid
Ascitic fluid
Allergy testing
Samples referred to other laboratories
Paediatric sample tubes
Table of sample requirements and reference ranges
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Telephone
(01904 72) 5670
Bleep
620
Alison Jones
Alison.jones@york.nhs.uk
Consultant Clinical Biochemist
(01904 72) 5786
500
Dr Daniel Turnock
Consultant Clinical Biochemist
(01904 72) 1847
Michelle Morgan
Secretary to Consultant Chemical Pathology team
(01904 72) 5855
Dr Deepa Narayanan
Consultant Chemical Pathologist
Mrs Joanna Andrewr
Joanna.andrew@york.nhs.uk
Head Biomedical Scientist
(01904 72) 5872
Mrs Joanna Andrew
joanna.andrew@york.nhs.uk
Operational Manager - York
(01904 72) 5802
Results & Specimen Enquiries/Office
(01904 72) 6802
Duty Biochemist
(01904 72) 6366
The Department is situated on the second floor of the Laboratory block and is open from 08:30 to 17:30 Monday to Friday.
Enquiries about results and specimens may be obtained from the office (01904 726802) 08:30 to 18:30 Monday to Friday.
Enquiries at other times should be made via the Biomedical Scientist (BMS) on duty (bleep 934) but these must be kept to a minimum.
Please use the CPD Pathview or the ICE Anglia reporting system whenever possible.
The CPD and ICE Anglia reporting system is available on the hospital network and is updated with completed results every 15 minutes
There is a Duty Biochemist available (01904 726366) from 09:00 to 17:30 Monday to Friday for advice or to discuss results.
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Other queries will be answered by the on-call consultant, contact via switchboard.
Frequency of assays
Most assays are performed daily but there are some assays performed less frequently dependant on numbers, clinical need and cost. Some samples are sent
away to other laboratories for testing.
Turnaround Times
Turnaround times of samples are calculated from the time of receipt of the sample in the laboratory to when the result has been validated and is available to the
user in electronic format. Receipt of hard copy reports may take considerably longer.
General Chemistry Tests
Turnaround times for general chemistries on routine non-urgent samples such as U&E, LFT, Bone profile, and CRP and blood glucose are as follows. From
receipt of samples the mean (50%) turnaround times for these tests is 45 minutes; 75% of samples are turned around in 1 hour and 95% of all samples analysed
and reported within 2½ to 3 hours.
Urgent samples about which we have been telephoned are turned around within one hour of receipt.
Endocrine Tests
For endocrine tests the turnaround times for 95% samples are as follows: thyroid function (24 hours), free T3 (24 hours), oestradiol, LH & FSH, & tumour
markers (all 48 hours), testosterone (3 days), B12 & ferritin (24 hours) from the time of receipt.
Referred Tests
Turnaround times for samples referred to third party laboratories for analysis can also be supplied. It should be noted that referral laboratories own figures do
sometimes differ considerably from actual experience.
Exact turnaround times for any tests can be supplied on request.
Request forms
These must be correctly filled in, preferably with the details printed in CAPITALS. It is essential that the HOSPITAL NUMBER and DATE OF BIRTH are included
whenever possible.
Urgent Requests must be telephoned to the office (6802 or bleep 934 out of hours) to alert the laboratory staff of their arrival. The request form must be
clearly marked URGENT. Results will not be telephoned without prior verbal notification.
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Out of Hours
The following tests are available:
U and E, Bicarbonate, serum Glucose, Liver Function Tests, Bone Profile, CK, Amylase, CSF Glucose, CSF protein, Paediatric Bilirubin, CRP, Urate (Maternity),
Theophylline, Digoxin, Salicylate and Paracetamol.
Xanthochromia screening for suspected SAH is performed routinely Monday – Friday between 9.00am and 5.30pm, and between 12.00pm and 3.00pm at the
weekend. For urgent analysis of xanthochromia outside of these hours, please contact the Duty Biochemist (01904 726366) or the on-call consultant (via the
hospital switchboard) to discuss the patient
Requests for other analytes should be discussed with the Duty Biochemist (01904 726366) or on call- consultant via the hospital switchboard.
The department operates a shift system and there is a BMS in the hospital at all times. Outside routine hours only one BMS is on duty and they are often
extremely busy. Please be patient and bleep them only when absolutely necessary.
Blood gases and ionised calcium at York Hospital
These are measured on the machines in ICU. There are also machines in CCU, AMU, SCBU, Delivery and the Emergency Department. Samples from ward
based patients are analysed by healthcare staff on one of these analysers.
Samples for ionised calcium from out patients and general practice are measured by laboratory staff. A brown top serum sample with no air bubble is required
for this analysis.
Reports
Most reports are available to view on CPD and completed reports are uploaded electronically every 15 minutes for the hospital. The reports for GP surgeries are
sent electronically with regular uploads every 2 hours during the day and evening. Some paper reports are still produced and delivered by internal and external
mail.
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TEST REQUESTING
We are able to measure over a hundred analytes in the laboratory and we can also arrange for specimens to be sent to other laboratories for measurements of
analytes not performed at York.
Routine Tests
We are able to perform measurements of single analytes if required but in practice tests tend to be grouped with other inter-related tests. These are as follows:
Bone
Albumin
Alkaline phosphatase
Calcium
Phosphate
Cardiac Markers
Troponin I (cTnI).
Liver
Alanine aminotransferase (ALT)
Albumin
Alkaline phosphatase (ALP)
Bilirubin
Total protein
Renal
Sodium
Potassium
Urea
Creatinine (includes eGFR)
These test groups can be requested by ticking the appropriate boxes on the request form. If you only require a single test or selected tests from a group please
indicate which tests are required by writing their names in the space below the request boxes. THIS IS ESPECIALLY IMPORTANT WITH LOW-VOLUME
PAEDIATRIC SAMPLES when there may be insufficient sample to perform all the requested tests. The order in which the tests are written will determine
priorities during sample analysis. This will ensure that the most needed tests are performed first.
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Sample Requirements
There is a comprehensive list of samples required for each test detailed later on in this handbook as well as the frequency of analysis with reference ranges
where appropriate. The sample required to analyse all the tests listed in the previous section is 7.5ml of clotted blood. There is also a summary of sample
requirements on the back of every pathology request form.
24h urine collections
The following assays require the urine collected into a bottle containing acid preservative
calcium
metanephrines (can be collected in a plain bottle if HIAA is not also required)
citrate
cystine
Hydroxy-indole acetic acid (HIAA)
magnesium
oxalate
phosphate
The following assays require the urine collected into a plain bottle (no preservative)
arsenic
cortisol
creatinine
total protein
urate
urea and electrolytes
copper
mercury
Requesting further tests on samples already received in the laboratory
We keep most of the samples we receive for approximately 3 days before they are discarded. Some samples are kept longer depending on the tests requested.
If you want to add further tests to a sample please ring (01904 72)6802 option 1. We will check if we still have the sample and then add the tests. Please note
that some analytes are labile and deteriorate rapidly. In these cases you we will tell you that the sample we have left is unsuitable and fresh sample will have to
be taken.
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Reference Ranges
Age and sex related reference ranges are printed on the report forms alongside the results.
eGFR
The National Service Framework (NSF) for Renal Services has recommended that kidney function is measured by serum creatinine concentration together with
a formula-based estimation of glomerular filtration rate (eGFR), calculated and reported automatically by all clinical biochemistry laboratories on samples from
people who are aged 18 years and over. The formula is not recommended for some specific groups (children, acute renal failure, pregnancy, oedematous states,
muscle-wasting disease, amputees and malnourished patients).
Guidance on further investigation and management of patients with chronic kidney disease can be found at http://www.renal.org/information-resources/the-ukeckd-guide.
We use a formula to estimate the GFR based on the Modification of Diet in Renal Disease (MDRD) equation using the serum creatinine concentration, age and
sex of the patient. In addition all reports indicate a further multiplication which should be made to the reported value if the patient is of African-Caribbean ethnic
origin (If the patient is of afro-Caribbean origin multiply eGFR by 1.212). The calculation we make also incorporates correction factors which take into account
the particular method and analyser that we use to measure the serum creatinine. These correction factors have been implemented across the UK to improve
inter-laboratory agreement and aid correct diagnostic classification.
Therapeutic Drug Monitoring (TDM)
We provide a service for the monitoring of serum concentrations of a number of drugs. If a drug assay is required the following information is helpful:
•
•
•
•
Time of last dose
Duration of therapy
Co-administered drugs
Reason for request
The department offers a service for: Lithium, Tacrolimus, Theophylline, Phenytoin, Phenobarbitone, Carbamazepine, Sodium valproate, Primidone, Digoxin,
Paracetamol and Salicylate. We send samples to other laboratories for the measurement of Sirolimus and Ciclosporin.
The sampling time should be as follows:
Carbamazepine
Digoxin
Immediately before next dose
>6 hours post dose
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Lithium
Phenytoin
Phenobarbitone
Primidone
Sodium valproate
Theophylline
Theophylline (sustained release)
Tacrolimus
Sirolimus
Ciclosporin
12 hours post dose
At any time
Immediately before next dose
Immediately before next dose
Immediately before next dose
2 hours post dose
4 hours post dose
Immediately before next dose
Immediately before next dose
Immediately before next dose
Phenytoin is bound to albumin in blood and therefore in patients with albumin levels below 40g/L an adjustment can be calculated where appropriate.
Adjusted phenytoin (mg/L) =
measured phenytoin
[(0.02 X serum albumin) + 0.1]
Drug Analysis in Overdose Cases
The Biochemistry department offers analysis of various drugs in patients where overdose is suspected. This includes:
carboxyhaemoglobin
iron
lithium
paracetamol
salicylate
theophylline
phenytoin
blood alcohol.
Samples for tricyclic antidepressants and barbiturates are sent to another laboratory
Please contact the laboratory to discuss your requirements if necessary.
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Screening for Drugs of Abuse
We offer a clinical screening service for drugs of abuse. We require a random urine sample collected into a plain container. We always measure the urine
creatinine concentration in these samples because if the urine is very dilute any drugs present may be there in concentrations that are below the cut-off value to
give a positive result. We screen for the presence of 7 commonly abused drug classes (or their metabolites).
Amfetamines (includes methylated amfetamines such as ecstasy)
Benzodiazepines
Cannabis
Cocaine
Methadone metabolites
Opiates
6 monoacetyl morphine
Some other drugs will give positive results with our amfetamine and opiate screens. For this reason samples that are shown to be positive for the presence of
amfetamines or opiates are further investigated using chromatography to check there is amfetamine (or a derivative) or morphine present respectively.
We are often asked how long drugs will remain detectable in urine after consumption. Below is a table with approximate times.
Drug
Amfetamines
Benzodiazepines
Cannabis
Cocaine
Methadone metabolites
Opiates
6 monoacetyl morphine
Approximate retention time
1-3 days
12 hours to 6 weeks (depends on the type of benzodiazepine)
Up to one month (depends on previous consumption)
1-3 days
1 day
1-2 days
12-24h
We will also screen for individual drugs if you do not want to screen for all of the 7 drugs in the above panel. Please indicate the drug(s) that you want to screen
for on the request card.
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Blood Sampling For Lipids
Serum total cholesterol and HDL cholesterol may be measured in a non-fasting sample. When serum triglycerides are also required the blood should be taken
after a fast of 12-14h. In all cases the blood should be taken with minimal venous occlusion after the patient has been sitting for 10 minutes.
LDL is calculated from the total cholesterol, HDL cholesterol and triglyceride concentration from a fasting sample provided that the triglyceride level is below 4.5
mmol/L.
Fasting Times
Triglycerides – 12-14h
For most other tests that require the patient to be fasted an overnight fast of 10h (e.g. 11pm to 9 am) is sufficient. These tests would include glucose, iron, and
some dynamic function tests.
Specimen Collection for Plasma Metadrenalines
•
EDTA blood specimen, at least 5-7 ml of blood.
•
Collection of sample should be carefully controlled to avoid stress-related increases in catecholamine levels.
•
Collect an EDTA blood samples and transport on ice to Clinical Biochemistry Department within 30 minutes of collection. Sample must be kept cold but is
viable for up to 20 minutes without ice and for 30-60 minutes with ice.
Dynamic Endocrine and Metabolic Function Tests
Glucose Tolerance Test
•
Patients should be asked to fast from 11:00 pm the night before, but may drink small volumes of water.
•
Patient should be advised not to smoke on the morning of the test and until the test is over.
•
On arrival, preferably at 09:00, collect 2.5mls blood for fasting blood glucose in fluoride oxalate (yellow top). Label as “fasting sample” and “time 0”
•
The patient is then given one of the following solutions: (equivalent to 75g of glucose anhydrous BP).
-
Glucose Tolerance Test solution 75g (300mL, obtained from the Pharmacy Department of York Hospital) or
410mL of Lucozade energy original (70 kcal/100mL strength, please check the label on the bottle to confirm the strength).
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-
(NB there are other Lucozade products besides energy original but these should not be used as they contain other ingredients).
In children the dose is weight related – 1.75g/kg body weight up to a maximum load of 75g.
•
The patient must drink the glucose solution over five minutes and must rest after receiving it and not walk around.
•
Unless specifically asked for, only one further specimen is collected at 120 min after the glucose drink has been given. This sample should be clearly
labelled “120 min”
•
If the patient feels sick some more water may be given.
•
If the patient vomits test is abandoned and the laboratory is informed.
•
All samples should be labelled clearly with times and sent to the laboratory for analysis.
•
The patient should be given tea or coffee and biscuits before leaving.
Short Synacthen Test for suspected adrenal failure
•
The test should be performed in the morning as the cortisol responses may differ between the morning and late afternoon
•
Allow the patient to rest quietly for about half an hour.
•
09:00 collect blood into a brown top monovette tube for cortisol. Clearly label this tube with the time and “baseline”. Also collect blood into a red top
EDTA monovette tube for ACTH and send this sample directly to the laboratory on ice as ACTH is labile.
•
Inject 250µg of Synacthen i.m. or i.v. (Dose for children is 36 µg/kg body weight up to a maximum of 250 µg)
•
09:30 collect a further sample of blood into a brown top monovette tube for cortisol. Clearly label this tube with the time
•
10:00 collect a further sample of blood into a brown top monovette tube for cortisol. Clearly label this tube with the time
Protocols for other dynamic tests are available from the Duty Biochemist (01904 726366).
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Pregnancy Tests (hCG)
Pregnancy test kits are available from the department (available at cost price for GP surgeries) and this point of care test should be used wherever possible. The
device has a sensitivity of 20 IU hCG/L and will become positive by the day of the first missed menstrual period in the vast majority of pregnant women. Early
morning urine is the preferred sample but random urines can also be used. A protocol for the use of this device is available from the laboratory.
Where the point of care device is not available the laboratory will perform this test. Please send a random urine sample in a plain container. Alternatively the
laboratory can also measure hCG in serum. Please send a blood sample collected into a brown top tube.
In suspected ectopic pregnancy serum hCG is measured. Please telephone to inform the laboratory if a serum hCG is required urgently.
Hypoglycaemia in children
Instructions and sampling kits for the investigation of hypoglycaemia in children are available on SCBU, Ward 17 and Child Assessment Unit. Please ring Main
Laboratory Reception on 6542 (or contact the BMS via bleep 934 out of hours) if you require a further kit.
CSF sampling for suspected subarachnoid haemorrhage
Instructions and sampling kits are available from Main Laboratory Reception (6542) and Biochemistry (6802 or bleep 934 out of hours) for the investigation of
CSF in suspected subarachnoid haemorrhage. Please follow the instructions carefully. Samples for spectrophotometric scanning should NOT be sent in the
pneumatic tube.
Pleural Fluid
The British Thoracic Society (Hooper C, Lee YCG, Maskell N. Investigation of a unilateral pleural effusion in adults. Thorax 2010; 65: Supplement 2, ii4-ii17),
recommends that Light’s criteria are used for patients not receiving (or recently receiving) diuretics. Serum and effusion total protein and LDH should be
measured. Fluid is an exudate if any of the following criteria are met
Fluid:serum protein ratio >0.5
Fluid LDH >67% of the upper limit of normal for serum (i.e. >166 U/L in our laboratory)
Fluid:serum LDH ratio >0.6
An alternative is to use the serum-effusion albumin gradient (SEAG). Serum albumin and effusion albumin are measured and then the effusion albumin value is
subtracted from the serum albumin value.
SEAG <12g/L is an exudate,
SEAG >12g/L is a transudate
This has been found to be useful in classifying patients on diuretics or who have recently been on diuretics.
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Ascitic fluid
Measure the fluid total protein
Levels below 25-30 g/L classed as “transudates” (cirrhosis, CCF, nephrotic)
Levels above 25-30 g/L classed as “exudates” (inflammation or infection)
An alternative to the exudate-transudate concept is Serum Ascites Albumin Gradient (SAAG). Serum albumin and ascitic fluid albumin are measured.
SAAG = <11 g/L (low albumin gradient) associated with inflammation and infection
SAAG = > 11 g/L (high albumin gradient) associated with portal hypertension
Allergy testing and Specific IgE analysis
We test for most common allergens by measuring specific IgE to the particular allergen and can also send samples to a reference laboratory for some of the less
common specific IgE tests.
We offer several panels of allergy tests:Inhalant panel: HDM, Cat dander, Dog dander, Timothy grass, Rye Grass, Cladosporium herbarum, Birch and Mugwort.
Tree panel: Alder, Silver Birch, Hazelnut, Oak and Willow.
Mould panel: Penicillium notatum, Cladosporium herbarum, Candida albicans, Aspergillus fumigatus and Alternaria tenuis.
Weed panel: Ox-eye daisy, dandelion, plantain, golden-rod and Lamb's quarters.
Rodent panel: Guinea pig, Hamster, Rabbit, Rat and Mouse
Feather panel: Goose, Chicken, Duck and Turkey.
Food panel: Milk, egg, cod, wheat, peanut and soybean.
Fish panel: Cod, tuna, salmon, blue mussel and shrimp.
Mixed nut panel: Hazel, Brazil, Almond, Peanut and Coconut.
If you only request total IgE we will not do any further allergy tests. If the patient’s history suggests possible allergens then we recommend that you request these
as individual tests.
Several points should be borne in mind when interpreting results of allergy tests. Firstly the presence of a specific IgE to an allergen indicates sensitisation but
does not necessarily indicate clinical allergy. Secondly in atopic individuals the requesting of multiple allergy tests is likely to be of little clinical benefit. There is
also little benefit repeating allergy tests, which have already been found to be positive.
Dr Philip Wood, the Consultant Immunologist, is available for clinical advice on 07525055670.
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Samples referred to other laboratories
Some samples are sent away to other laboratories for analysis. A detailed spreadsheet of where we send these tests is accessible here. For information about
turnaround times please contact the Duty Biochemist on 01904 726366.
Referred Samples.xls
Paediatric sample tubes
In the table below the sample type is listed in the second column. Each cell is colour coded for the stopper of the Sarsdedt tube to be used for the blood sample.
Paediatrics do not use the Sarstedt blood collection system so for all serum samples (brown top tubes) please use the white topped paediatric tubes.
All other blood tube colours are the same (orange, yellow and pink)
NB In the table below there are white cells but these are for non-blood samples such as urine or faeces and these samples should be collected in the
appropriate containers.
SAMPLE REQUIREMENTS, REFERENCE RANGES & TURNAROUND INFORMATION
Information.doc
Double click icon to open
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HAEMATOLOGY AND BLOOD TRANSFUSION DEPARTMENT
1. Haematology tests
2. Special Investigations
3. Normal ranges
4. Anticoagulant (Warfarin) Clinic
5. Transfusion Tests
Extension
Consultant Haematologists
Dr M R Howard (Laboratory Lead)
5586
Dr L R Bond
5671
Dr L Munro (Clinical Lead)
5892
Dr A Whittle
1980
Secretarial Support
Mrs C Jepson and Mrs V. Capes (MRH & LRB)
Mrs E. Calpin (LM & AW)
Mrs H Atkin (assistant medical secretary – mornings)
Mrs M Hunt (assistant medical secretary – afternoons)
5854
5777
5851
5851
Key Laboratory Contacts (Biomedical Scientists)
Mr C. Smith (Head BMS)
Mr M. Skelton (Operational Manager - York)
Mr K. Foster (Blood Transfusion)
Miss A Buxton (Immunology)
5891
6189
6334
5738
Transfusion Practitioner
Mrs C Ivel
Specimen and Result Enquiries
5830
6802
Bleep
997
616
639
Wireless telephone 4518
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HAEMATOLOGY
Location & Opening Times
The Department is situated on the second floor of the Laboratory block and is open from 08:30 to 17:30 Monday to Friday.
Outside these hours the department operates a shift system and there is a minimum of one BMS in the hospital at all times.
Enquiries about results and specimens may be obtained from the office (01904 726802) 08:30 to 18:30 Monday to Friday.
Enquiries at other times should be made via the Biomedical Scientist (BMS) on duty (bleep 842) but these must be kept to a minimum.
Please use the CPD Pathview or the ICE Anglia reporting system whenever possible.
The CPD and ICE Anglia reporting system is available on the hospital network and is updated with completed results every 15 minutes.
Instructions for completion of the request form
Please complete the request form in capitals.
Patient details required include; a full name, date of birth, hospital number/NHS number, patient category, location and clinical details
Request details include; the test, sample type, date and time of the sample, date of the request
Requestor details include; specialty consultant or GP, the name and signature of the requesting doctor, contact details including bleep number
Please use the CPD or the ICE Anglia reporting system whenever possible. The ICE Anglia reporting system is available on the hospital network and is
updated with completed results every 15 minutes.
The Haematology consultant on call will answer other queries. Please only contact them via hospital switchboard.
Frequency of assays
Most assays are performed daily but there are some assays performed less frequently dependant on numbers, clinical need and cost. Some samples are sent
away to other laboratories for testing.
Test Repertoire
The following table lists the full repertoire of tests available from York Hospital. If you require a test outside this list, please contact the laboratory for further
advice. Clinical advice or interpretation can be sought at any time through a consultant haematologist. The Consultants and Laboratory Haematology Staff are
happy to be consulted regarding the selection of tests and to aid in the interpretation of abnormal results. Please note:
1. Turnaround times are calculated from the time of receipt in the laboratory to the time when the report is available to the user in an electronic format. Times
quoted are calculated on the turnaround times of 95% of requests.
2. “Urgents” are defined as telephoned requests to the department. If “Urgents” are not requested by phoning they may be treated as routine.
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3. It is imperative that ALL patient requests have appropriate Clinical Details recorded because secondary laboratory tests may be generated on the basis of
laboratory results and this information.
Additional examinations may be requested up to 24h for coagulation samples and up to 3 days for haematology samples, however requests for blood films,
malaria parasite screening and ESR testing are best performed on fresh samples that are <24h old.
Test
Specimens
Required
Anti- Factor Xa
assay (LMWH or
Danaparoid
monitoring)
(Apixaban,
Rivaroxaban and
Fondaparinux sent to
Sheffield)
APTT Ratio
Citrate
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used
2 x 3mL (adult)
2 x 1mL (paed)
.
4 hours (urgent)
7 days (routine)
Contact
Consultant
Haematologist
for advice.
No need to monitor
LMWH’s or DOAC’s in all
patients. Contact
Consultant Haematologist
for advice.
Citrate
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used
Bone marrow
aspirate ± trephine
1 x 3mL (adult)
1 x 1mL (paed)
.
45 minutes if urgent.
4 hours routine.
Therapeutic
range 1.5 to 2.5.
Used for patients on
unfractionated heparin
therapy (not LMWHs).
Use pharmacy protocol for
dosing.
N/A
Contact Consultant
Haematologist for
advice.
N/A
Contact Consultant
Haematologist for advice.
CD4 (Leeds) (see
also T-cells)
EDTA
Minimum 3mL
Need to be
analysed within 24
hours
Varies - contact
Consultant
Haematologist for
advice.
3 working days
Chromosome
analysis (karyotype)
-St. James
Lithium Heparin
(blood samples)
Whole blood
(10mL Lithium
Heparin)
Bone marrow (1mL
in Lithium
Heparin/Hanks)
Test for ‘Fragile X’
required 10mL
lithium heparin &
5mL EDTA whole
blood
Contact
Consultant
Haematologist
for advice.
N/A
Samples referred to St
James Hosp (Leeds)
Ideally send samples am
M-F
Appropriate tubes
available from specimen
reception
Bone Marrow
Lithium
Heparin/Hanks
solution (bone
Special
Precautions
Sample Volume
1, 2
Turnaround Time
7-36 days
(peripheral blood)
6-28 days (bone
marrow)
Reference
Range
Key Factors
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Test
Clotting factor
assays (including
von Willebrands)
Specimens
Required
marrow samples)
Citrate
Sample Volume
Special
Precautions
1, 2
Turnaround Time
2 x 3mL (adult)
4 x 1mL (paed)
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
4 hours if urgent.
3-6 weeks routine.
Coagulation
Inhibitors
Citrate
2 x 3mL (adult)
2 x 1mL (paed)
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
Same day if urgent
(agreed with
Consultant
Haematologist).
3-6 weeks routine.
Coagulation Screen
(PT, APTT +
Fibrinogen)
Citrate
1 x 3mL (adult)
1 x 1mL (paed)
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
45 minutes if urgent.
3 hours routine.
D-Dimer
Citrate
1 x 3mL (adult)
1 x 1mL (paed)
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
45 minutes if urgent.
3 hours routine.
DNA studies-St.
James
EDTA
5 – 10mL (adult)
Minimum 1mL
(paed)
Fragile X test
requires 10mL
lithium heparin
AND 5mL EDTA
1 – 2 weeks
Reference
Range
Varies –
reference range
printed on final
report.
Ranges available
from laboratory
staff
Varies –
reference
range(s) printed
on final report.
Available from
laboratory staff
Printed on final
report. Subject to
change due to
reagent changes.
Current ranges
available from
laboratory staff.
Printed on final
report. Subject to
change due to
reagent changes.
Current ranges
available from
laboratory staff.
N/A
Key Factors
Contact laboratory for
advice on relevance of
tests and sample volumes
BEFORE taking bloods.
Contact laboratory for
advice on relevance of
tests and sample volumes
BEFORE taking bloods.
Indicate on request form
if patient receiving any
anticoagulant drugs.
Please state clearly why
this investigation is
required and provide
clinical details.
Refer to trust protocol
Store overnight samples
at 4ºC if necessary.
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Specimens
Required
Test
Sample Volume
Erythropoietin
Serum
0.5 – 1.0 mL
EPO receptor gene
mutation analysis &
VHL gene analysis
EDTA
5mL
ESR
EDTA
1 x 3mL
Factor V Leiden
Citrate
Full Blood Count
(FBC)
Fibrinogen
EDTA
1 x 3mL (adult)
1 x 0.5mL (paed)
1 x 3mL (adult)
1 x 0.5mL (paed)
3mL (adult)
1mL (paed)
Film examination
Hb A2 assay
Citrate
4
EDTA
1 x 3mL (adult)
1 x 0.5mL (paed)
EDTA
1 x 3mL (adult)
Special
Precautions
sample
Do not freeze.
Store overnight
samples at 4ºC if
necessary.
Please post
Monday –
Thursday only
Please note this
sample can be
used for both the
FBC and ESR test.
Not suitable if on
heparin
Do not overfill
samples
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
Prepared from
FBC sample.
Bone marrow films
examined by
Consultant
Haematologists
Reference
Range
Key Factors
4 weeks
Available on final
report
Please state most recent
Hb & PCV
Contact laboratory
for expected
turnaround time (Tel
02890 329241 ext.
3361)
60 minutes if urgent.
5 hours routine.
N/A
1, 2
Turnaround Time
Up to 4 weeks
30 minutes if urgent.
4 hours routine.
45 minutes if urgent.
3 hours routine.
2 hours if urgent. 3
days routine.
Up to 3 days
Male: 0-10
mm/Hr
Female:0-15
mm/Hr
N/A
Samples should be as
fresh as possible.
Discuss with lab before
requesting.
See below for
FBC ranges.
Printed on final
report. Subject to
change due to
reagent changes.
Current ranges
available from
laboratory staff.
See below for
reference
ranges.
Very abnormal blood films
referred to Consultant
Haematologist
1.8 – 3.5%
Included as part of
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Test
Specimens
Required
Hb F assay
EDTA
HBH inclusion
bodies
EDTA
Haemoglobinopathy
Screen – including
Sickle Test
Hb electrophoresis
Sample Volume
Special
Precautions
2 x 0.5mL (paed)
1 x 3mL (adult)
2 x 0.5mL (paed)
1, 2
Turnaround Time
Reference
Range
Up to 3 days
0.2 – 1.0 %
1 x 3mL (adult)
2 x 0.5mL (paed)
Up to 3 days
N/A (normal is
absent)
EDTA
1 x 3mL (adult)
2 x 0.5mL (paed)
Up to 3 days
EDTA
1 x 3mL (adult)
2 x 0.5mL (paed)
Up to 1 week
Issued with final
report &
interpretation
N/A
Immunophenotyping
(cell markers,
HMDS)
EDTA
Bone marrow
Fresh sample
required (24 hours
max)
Up to 10 days
N/A
IM Screen (for
Glandular fever)
EDTA
1 x 3mL EDTA
(adult) or 2 x
0.5mL EDTA
(paediatric)
Approx 1mL bone
marrow in EDTA
1 x 3mL EDTA
(adult)
1 x 0.5mL EDTA
(paed)
Need EDTA
sample if FBC
required also
75 minutes if urgent.
6 hours routine.
72 hours for full
report including
blood film
comments.
45 minutes if urgent.
3 hours routine.
N/A
or
Serum
INR
Citrate
~1mL serum
1 x 3mL (adult)
1 x 1mL (paed)
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
N/A – target INR
depends on
reason for
anticoagulation
Key Factors
haemoglobinopathyscreen
Included as part of
haemoglobinopathy
screen
Included as part of
haemoglobinopathy
screen
Please state ethnic origin
if known
Included as part of
haemoglobinopathy
screen
Available after discussion
with Consultant
Haematologists
This test is indicated for
the control of oral
anticoagulant drugs
only
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Test
Lupus inhibitor
screen
Specimens
Required
Citrate
Sample Volume
2 x 3mL (adult)
2 x 1mL (paed)
Special
Precautions
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
Avoid testing
during acute postthrombic period
and if on
anticoagulants
Samples must
arrive before
2.30pm Friday &
before 4pm
Monday to
Thursday.
1, 2
Turnaround Time
Reference
Range
Key Factors
Same day if urgent.
Routine up to 21
days.
Issued with final
report and
interpretative
comments
Anticardiolipin antibody
assay indicated if
screening for
antiphospholipid
antibodies
2 weeks
N/A
Test by prior
arrangement only.
Lymph function
tests (St James,
Leeds)
EDTA
2 x 3mL (adult)
Malaria parasites
EDTA
1 x 3mL (adult)
1 x 0.5mL (paed)
All malarias are
treated urgently.
Please inform
laboratory to
expect sample.
Samples must be
as fresh as
possible.
1-2 hours
N/A
A single test where no
parasites are detected
cannot rule out malaria.
Always repeat for
confirmation, especially if
clinical symptoms persist.
10mL (adult)
5mL (paed)
1 x 3mL (adult)
Test to be prearranged with
Laboratory
72 hours
Issued with final
report.
Available after discussion
with Consultant
Haematologist
Osmotic fragility
EMA binding test
(send away to Royal
Please discuss
with Laboratory
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Test
Specimens
Required
Sample Volume
Special
Precautions
1, 2
Turnaround Time
Reference
Range
Key Factors
Manchester
Hospital)
p50 (oxygen
dissociation)
EDTA
5mL EDTA from
patient and a
normal control
PFA-100 (Platelet
function) (St James
Hospital)
EDTA
1 x 3mL EDTA and
1 x 3mL citrate
and
Citrate
Post samples
Monday –
Thursday to be
tested next
working day. Test
to be pre-arranged
with Laboratory.
Advice given on
pre-analytical
requirements
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used. Test to be
pre-arranged with
Laboratory. Advice
given on preanalytical
requirements
rd
1 week
Issued with final;
report.
3 line investigation of
absolute erythrocytosis.
Contact Consultant
Haematologist for advice.
1 week
Issued with final
report
Must give prior notice –
samples need to be
tested within 4 hours of
collection
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Test
Specimens
Required
Sample Volume
Special
Precautions
1, 2
Turnaround Time
Reference
Range
Key Factors
Plasminogen assay
(Sheffield)
Citrate
2 x 3mL (adult)
2 x 1mL (paed)
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used. Test to be
pre-arranged with
Laboratory. Advice
given on preanalytical
requirements
Contact laboratory in
Sheffield
Issued with final
report
Test rarely indicated available after discussion
with Consultant
Haematologist
Platelet aggregation
(Send away test to
St James)
Citrate
6 – 8 x 3mL (adult)
Discuss with lab for
paediatric
requests.
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used. Test to be
pre-arranged with
Laboratory. Advice
given on preanalytical
requirements
Tested on day
samples taken.
Report issued within
2 – 3 days.
N/A - qualitative
report issued
Samples must be in the
lab by 10am
Plasma Viscosity
(Scarborough)
Prothrombin Gene
Mutation
Reticulocytes
EDTA
3mL (adult)
7-10 days
Citrate
1 x 3mL (adult)
1 x 0.5mL (paed)
1 x 3mL (adult)
1 x 0.5mL (paed)
Issued with final
report
N/A
Store overnight samples
at 4ºC if necessary.
Discuss with lab before
requesting.
EDTA
None.
Up to 4 weeks
Automated
reticulocyte
available using
FBC sample.
Usually performed
routinely on
30 minutes if urgent.
4 hours routine.
< 2.0% (adult)
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Test
Specimens
Required
Sample Volume
Special
Precautions
1, 2
Turnaround Time
Reference
Range
Key Factors
paediatric FBC
requests.
Sickle-cell screen
EDTA
1 x 3mL (adult)
1 x 0.5mL (paed)
T-cells(CD4/CD8) –
(St James)
EDTA
3mL
Thrombophilia
Screen
Citrate
3 x 3mL (adult)
5 x 1mL (paed)
(Antithrombin,
Protein C, Protein S,
Thrombin Time,
Lupus Inhibitor,
Anticardiolipin,
Coagulation Screen)
and
Serum
1 hour if urgent
Up to 1 week
routine.
N/A
Need to be
analysed within 24
hours
2 working days
Contact
Consultant
Haematologist
for advice.
Tubes must be full
to line. Over- or
under-filled
samples cannot be
used.
3-6 weeks
Printed on final
report. Subject to
change due to
reagent changes.
Current ranges
available from
laboratory staff.
Avoid testing
during acute postthrombic period, if
on anticoagulants
or when pregnant.
Unstable Hb's
EDTA
1 x 3mL (adult)
3 x 0.5mL (paed)
24 hours
N/A
Urine Haemosiderin
Urine
20mL in a plain
sterile container
24 hours
N/A
A Sickle screen is always
followed up with a
Haemoglobinopathy
investigation
Samples referred to St
James Hosp (Leeds)
Ideally send samples to
lab before lunchtime
Monday – Friday.
Relevant clinical details
required on request form.
Requests may be referred
to haematologist
Requires fresh sample –
discuss with laboratory
staff before taking
samples.
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NOTE: Special Investigations
These include:
•
•
•
•
•
•
•
•
•
•
Red Cell Enzyme Tests e.g. G6PD
Immunophenotyping
Red Cell Membrane Tests
PNH
PFA 100
Platelet Function Tests
Bone Marrow Morphology
Clotting Factor Assays
FVIII Inhibitor assay
FIX Inhibitor assay (Send away to Sheffield)
Indications for these specialised tests are always best discussed directly with lab staff. This will clarify the need for the test and the most appropriate sample type
and patient information required.
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Normal Ranges:
Normal Adult ranges for routine Haematology tests are as follows: (for advice on neonatal ranges, pregnancy etc. please phone the laboratory):
Test
HB
WBC
PLT
RBC
MCV
PCV
MCH
MCHC
Neuts
Lymph
Mono
Eos
Baso
ESR
PT (automated)
APR (Heparin ratio)
APTT (automated,
part of coag screen)
FIB
AT3
Protein S Free
Antigen
Protein C Activity
Factor VIII
Factor IX
D-Dimer for PE
exclusion
D-Dimers for ?DIC
Lupus anticoagulant
Male
130-180
4-11
150-450
4.5-5.8
77-99
0.4-0.5
27-32
30-37
2-7.5
1.0 - 4.5
0.2-1.2
0.1-0.6
<0.2
1-10
10 – 12.0
1.5-2.5
26.0 – 36.0
Female
115-165
4-11
150-450
4.2-5.4
77-99
0.37-0.47
27-32
30-37
2-7.5
1.0 - 4.5
0.2-1.2
0.1-0.6
<0.2
1-15
10 – 12.0
1.5-2.5
26.0 – 36.0
Units
g/L
9
10 /L
9
10 /L
12
10 /L
fl
L/L
pg
g/dL
9
10 /L
9
10 /L
9
10 /L
9
10 /L
9
10 /L
mm/hr
seconds
Ratio
seconds
1.9-4.5
80 - 130
75 - 145
1.9-4.5
80 - 130
55 - 125
g/L
iu/dL
iu/dL
70-140
50 - 150
65 - 150
<230
70-140
50 - 150
65 - 150
<230
iu/dL
iu/dL
iu/dL
ng/mL
21-230
<1.2 = negative
21-230
<1.2 = negative
ng/mL
Ratio
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Test
screen ratio
Anticardiolipin IgG
Anticardiolipin IgM
Male
Female
Units
<10
<8.9
<10
<8.9
GPL units/mL
MPL units/mL
*These may change marginally depending on the reagents used for testing. Please contact the laboratory on ext 6326 if an exact normal range is required.
Paediatric Ranges (FBC):
Age
Birth
2 Weeks
2 Months
6 Months
1 Year
2 - 6 Years
6 – 12 Years
Hb
(g/L)
149 – 237
134 – 198
94 – 130
111 – 141
113 – 141
115 – 135
115 – 155
RBC
12
(x10 /L)
3.7 – 6.5
3.9 – 5.9
3.1 – 4.3
3.9 – 5.5
4.1 – 5.3
3.9 – 5.3
4.0 – 5.2
PCV
(L/L)
0.47 - 0.75
0.41 - 0.61
0.28 – 0.42
0.31 – 0.41
0.33 – 0.41
0.34 – 0.40
0.35 – 0.45
MCV
(fL)
100 – 135
88 – 120
84 – 105
68 – 82
71 – 85
75 – 87
77 - 95
WBC
9
(x 10 /L)
10.0 – 26.0
6.0 – 21.0
6.0 – 18.0
6.0 – 17.5
6.0 – 17.5
5.0 – 17.0
4.5 – 14.5
Neutrophils
9
(x 10 /L)
2.7 – 14.4
1.8 – 5.4
1.2 – 7.5
1.0 – 8.5
1.5 – 8.5
1.5 – 8.5
1.5 – 8.0
Lymphocytes
9
(x 10 /L)
2.0 – 7.3
2.8 – 9.1
3.0 – 13.5
4.0 – 13.5
4.0 – 10.5
1.5 – 9.5
1.5 – 7.0
Monocytes
9
(x 10 /L)
0.0 – 1.9
0.1 – 1.7
0.1 – 1.7
0.2 – 1.2
0.2 – 1.2
0.2 – 1.2
0.2 – 1.0
Eosinophils
9
(x 10 /L)
0.0 – 0.84
0.0 – 0.84
0.1 – 0.80
0.3 – 0.80
0.3 – 0.80
0.3 – 0.80
0.1 – 0.50
Platelets
9
(x 10 /L)
150 -450
At All
Ages
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REFFERED WORK
Some tests are referred to other laboratories for investigation. The laboratory confirms all such laboratories are CPA accredited. Our full list of referral sites are
detailed below. Specific details of which tests are available in repertoire (above) and further details can be provided on request.
Bradford Royal Infirmary, Department of Haematology, Duckworth Lane, Bradford. BD9 6RJ.
Royal Hallamshire Hospital Department of Coagulation, Floor H, Sheffield Haemophilia and Thrombosis Centre, Glossop Road, Sheffield. S10 2JF.
Belfast Link Laboratories, Belfast City Hospital department of Haematology, Lisburn Road, Belfast, Northern Island, BT9 7AB.
City Hospital NHS Trust, Department of Haematology, Birmingham City Hospital, Dudley Road, Birmingham. B18 7QH.
Cytogenetics, St James University Hospital Yorkshire Regional DNA Laboratory, Beckett Street, Leeds. LS9 7TF.
HMDS, Leeds General Infirmary Blood Bank, Great George Street, A Floor, Jubilee Wing, Leeds. LS1 3EX
Department of Transplant Immunology, St James Hospital, Beckett Street, Leeds. LS9 7TF.
London School of Tropical Medicine, Keppel Street, London. WC1E 7HT.
Scarborough General Hospital, Department of Haematology, Woodlands Drive, Scarborough, YO12 6QL.
National Blood Service Red Cell Immunohaematology, Bridle Path, Leeds, West Yorkshire LS15 7TW
St James University Hospital Department of Blood Transfusion, Beckett Street, Leeds. LS9 7TF.
Department of Clinical Biochemistry & Immunology, LGI, Great George Street, Leeds. LS1 3EX
Central Manchester & Manchester Childrens Uni Hospitals, St Mary’s Hospital Department of Andrology, Hathersage Road, Manchester. M13 0JH.
Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital Oxford Medical Genetics Laboratory, Headington, Oxford, OX3 7LJ.
Sheffield, Northern General Hospital Herries Road Sheffield, South Yorkshire, S5 7AU
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ANTICOAGULANT (WARFARIN) CLINIC
This Pharmacy led clinic is open 0800-1700, Mon-Fri and can be contacted on Ext (72)6785/ (72)6787
Outside of these times an emergency service is provided by the On call Pharmacist, who is contacted by switchboard
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TRANSFUSION
1. Surgical Blood Order Schedule — York NHS Staff Room
2. Other Blood Products
3. Further Information
The importance of correct identification and sample labelling cannot be overstated. Each and every sample MUST be labelled with the Surname,
Forename, DOB and Hospital Number (in emergency cases the A&E number will be accepted) or NHS number for primary care patients. When
information to identify the patient uniquely is missing or incomplete then a new sample and request form will be required and will cause delays. X R
numbers are not acceptable.
Test
Sample
Requirements
EDTA X 1
Sample
Volumes*
4.9 ml
5 ml
Antibody Panel –
(for identification of
irregular
antibodies)
EDTA X 3
4.9 ml
Antibody Titre
EDTA X 1
Blood Group &
Antibody Screen
EDTA X 1
5 ml
4.9 ml
3X 4.9ml for
anti-D or c
4.9 ml
Cold Agglutinin
Titre
EDTA X 1
4.9 ml
Antenatal Screen
Special
Precautions
Maintain the
sample at 37°c
post collection
and during transit
to the laboratory.
Turnaround
Urgent
N/A
Turnaround
Routine
Within 24 hours
Depends on nature
of antibodies –
laboratory will
discuss
N/A
Depends on
nature of
antibodies –
laboratory will
discuss
Within 24 hours
45 mins
Within 6 hours
N/A
Within 24 hours
Key Factors
If anti-D or anti-c is present the
specimens will be referred to NBS,
Leeds for quantification.
The detection of atypical antibodies and
incompatibilities may cause unexpected
and inevitable delays.
Sample MUST BE KEPT WARM prior to
separation.
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Test
Crossmatch
Sample
Requirements
EDTA X 1
Sample
Volumes*
4.9 ml
Special
Precautions
Patients’ spun
samples are
o
stored at 4-8 C
for 7 days and
may be suitable
for subsequent
crossmatch
requests.
Turnaround
Urgent
45 mins
Turnaround
Routine
4 hours
Key Factors
Blood – [red cells] is provided in
accordance with the agreed “surgical
blood order schedule” – see below.
Exceptions to the schedule must be
discussed directly with the laboratory
staff.
The detection of atypical antibodies and
incompatibilities may cause unexpected
and inevitable delays.
Un-crossmatched blood may be issued
on Clinical demand only.
Blood can now be issued electronically
provided:
• Two electronic groups exist on
the database (One historical and
one for the current situation)
• The patient has no atypical
antibodies present. Electronic
Issue enables blood to be
available for the patient within
20 minutes rather than the
serological issue of 45 minutes.
The transfusion department will
undertake the decision to EI.
DCT
EDTA X 1
4.9 ml
45 mins
Within 24 hours
Genotype
EDTA X 1
4.9 ml
N/A
Usually within
24 hours
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Test
Heparin Induced
Thrombocytopenia
(HIT) Assay
Sample
Requirements
EDTA X2
and
Serum Gel X 1
Sample
Volumes*
10 mL
Special
Precautions
7.5 mL
Turnaround
Urgent
Screen test
completed within 2
hrs to exclude HIT.
If not excluded 1-3
days for
confirmation
HLA B27
EDTA X 1
4.9 ml
Store at room
temperature
N/A
Investigation of
Transfusion
Reaction
EDTA X 1
and
EDTA x 1
and
Urine
4.9 ml
CONTACT
LABORATORY
FOR ADVICE
Within 24 hours –
contact laboratory
Kleihauer
EDTA x 1 from
mother
EDTA x 1 from
baby (cord)
and
EDTA x 1 from
mother
EDTA x 1 from
baby (cord)
3 ml
Total of next
available
4.9 ml
N/A
4.9 ml
Turnaround
Routine
Screen test
completed
within 2 hrs to
exclude HIT.
If not excluded
1-3 days for
confirmation
6 weeks –
contact
laboratory if
needed sooner.
Within 24 hours
Within 48 hours
– usually 6
hours
Key Factors
Samples referred to Bristol NBS if
screening does not exclude HIT, discuss
with laboratory staff before taking
samples.
Samples referred to Tissue Typing
Laboratory, St. James University
Hospital, Leeds
USER MUST CONTACT
LABORATORY
Return all transfused blood packs
A Kleihauer test is a prerequisite for all
th
Anti-D prophylaxis after the 20 week of
pregnancy.
3 ml
3 ml
* For paediatric patients, smaller volumes (approximately 1 ml) are acceptable – please contact the laboratory for further advice if necessary.
Other Blood Products
• Human Albumin – 4.5% and 20% available only after discussion with laboratory staff
• Fresh Frozen Plasma
]
Available only
• Platelets
]
after discussion
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•
•
Cryoprecipitate
Coagulation Factors
]
]
with laboratory
staff
Other products such as Prothrombin complex (Beriplex) and Novo 7 are available
Further Information
The Removal of Crossmatched Blood from the Blood Bank
Only staff trained in the procedure for electronically signing out products from the Blood Track Kiosk should remove blood from the issue blood fridge.
The Return of Crossmatched Blood to the Blood Bank
Blood may be returned to the Issue Blood bank within 30 minutes of removal. Outside of this time please contact the laboratory Ext 5739 or out of hours bleep the
duty haematologist
Emergency O Rh (D) Negative Blood
This is available for any immediate requirements and is located on the top shelf of the Issue Blood Bank. The units must be scanned out using the electronic Blood
Track Kiosk
The laboratory MUST be informed via Extension 5739 (or Bleep number 842 out of normal working hours)
1. Patient details must be entered on the Luggage Label.
2. The Luggage Label must be then detached and returned to the laboratory as soon as possible after the blood is used.
Checking Procedure for Blood and Blood Products
Details of this important procedure may be found in York Hospital Transfusion Policy. See Trust intranet Staff Room: Home › Policies and Procedures › Clinical
Documents › Blood Transfusion › Blood Transfusion Policies, Procedures, Protocols etc.
Blood transport
Blood in transit boxes are available for all remote sites and for use on site if blood is expected to be outside of temperature control for more than 30 minutes.
Please place a cool pack in the transit box. Temperature control will be maintained for up to 4 hours
REFERRED WORK
Some tests are referred to other laboratories for investigation. The laboratory confirms CPA status of all such laboratories. Our full list of referral sites for Blood
Transfusion work is detailed below. Specific details of which tests are available in repertoire (above) and further details can be provided on request.
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National Blood Service
Red Cell Immunohaematology, Bridle Path, Leeds, West Yorkshire LS15 7TW
Histocompatibility Laboratory, Langley, Lane Sheffield, S57JN
Histocompatibility and Immunogenetics Dpt., 500 North Bristol Park, Filton, Bristol, BS34 7QH
St James University Hospital Department of Immunology, Floor 9, Gledhow Wing, Leeds. LS9 7TF.
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IMMUNOLOGY DEPARTMENT
1. Samples
2. Tests performed at York Hospital
3. Tests referred to other hospitals
Useful Information
Telephone Numbers
Dr P Wood
0113 206 7256
Consultant Clinical Immunologist (St James’s)
Secretary
Immunology
Laboratory
0113 206 7256
(01904 72) 5738
(York Hospital)
Miss A Buxton
Senior BMS Immunology
(01904 72) 5738
Samples
All tests for autoantibodies can be performed on a single 7.5mL clotted sample collected into a plain tube. Requests for additional immunology tests can be
made for up to 6 weeks.
Frequency of testing
The following assays are performed daily (Mon-Fri) Antinuclear antibody screen, ANCA, anti-GBM and Liver related antibodies, Rheumatoid factor, Coeliac
screening, Intrinsic Factor antibody and Immunoglobulins.
All other assays are performed once a week.
Urgent Glomerular Basement Membrane antibody assays will be performed if appropriate, on patients with suspected systemic vasculitis and or acute renal
failure.
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Turnaround Times
Turnaround times are calculated from the time of receipt in the laboratory to the time when the report is available to the user in an electronic format. Paper
copies of reports will take longer than the stated times.
As a guide Immunology tests are processed and reported electronically within the following times:
5-7 days - Antinuclear antibodies, Rheumatoid Factor, ANCA, Coeliac screening, Liver antibodies, Intrinsic Factor antibody, GBM
7-14 days - Tissue specific antibodies, ENA profiles, anti-dsDNA, ENA screens.
Turnaround times for tests, e.g. neurological antibodies, referred to third part laboratories can be supplied on request; as a rule these take about 21 days to be
processed. Information on referral laboratories may be obtained by contacting the Immunology Laboratory ext 5738.
Diagnosis and Monitoring of SLE/SCLE/LUPUS/MCTD
Initial screen: ANA, CRP. (ENA and cardiolipin antibodies if pregnant).
Further tests if screen is positive: - anti-dsDNA, antibodies to ENAs, Cardiolipin antibodies, C3, C4, Immunoglobulin levels.
Monitoring: The half-life of antibodies is 3 weeks; therefore serial measurement of antibodies at weekly or fortnightly intervals is unhelpful. At each visit
measurement of C3, C4, and CRP is advised with intermittent measurement of ANA and DNA antibodies.
Systemic Vasculitides
Initial screen: ANA, ANCA, C3, C4, CRP, RF, Immunoglobulins and Cryoglobulins.
Diagnosis: In patients with active untreated Wegener’s granulomatosis, c-ANCA is present in >90% of cases. Although p-ANCA occurs in microscopic
polyarteritis, idiopathic pauci-immune glomerulonephritis and in a few patients with Wegener’s, they are also present in a range of other autoimmune diseases
e.g. SLE, RA, Ulcerative colitis.
Monitoring: In Wegener’s patients CRP and ANCA at each visit. The half-life of the antibody is 3 weeks; frequent ANCA measurement i.e. weekly/fortnightly is
unlikely to provide clinically useful information. In patients in remission, rising ANCA titres often precede a relapse.
Investigation of Renal Failure
ANA, C3, C4, CRP, ANCA, anti-GBM, cryoglobulins.
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Serum immunoglobulins and electrophoresis
Urine electrophoresis
Monitoring bacterial infection: CRP
In view of its short half-life (6hrs approx) alternate day measurement is advised to check response to treatment.
Suspected Immunodeficiency
Please discuss with The Clinical Immunologist prior to requesting tests.
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Immunology tests performed at York Hospital
Test Name
Report/Reference range
Adrenal Antibodies
ANCA
Negative or positive
Negative or positive (Plus staining pattern
of cytoplasmic c-ANCA or perinuclear pANCA).
Anti-nuclear antibody (ANA)
Cardiolipin antibodies IgG
Cardiolipin antibodies IgM
Negative or positive (titres and staining
pattern).
0 –10 GPL Units/ml
0 – 8.9 MPL Units/ml
Centromere antibodies
Negative or positive (titres)
Anti-Citrullinated Protein antibody
(Anti-Citrullinated Vimentin)
Coeliac screening
Anti-Tissue Transglutaminase
0 – 18.9 Units/ml
dsDNA antibodies
(only if ANA positive)
ENA's (Extractable Nuclear Antigens)
Ro La Sm RNP Jo-1 Scl-70
Epidermal antibodies
Intracellular substance ICS
Basement membrane BM
0 – 17.3 IU/ml
0 – 10 Units/ml
Further tests if initial test
positive &/or relevant clinical
details
ANA, C3, C4, CRP, RF
Anti-MPO units/ml
Anti-PR3 units/ml
dsDNA, ENA, cardiolipin
antibodies
dsDNA, C3, C4
At the request of Consultant
Rheumatologists
IgA endomysial antibody to
confirm positive anti-tTG and IgG
endomysial antibody if IgA
deficiency suspected.
C3, C4, CRP
Negative or positive
Negative or positive
IgG & C3 deposits in skin
biopsies (Histology Dept)
Clinical significance
Addison's, primary ovarian failure
c-ANCA: Wegener's, microscopic
polyarteritis.
o
p-ANCA: microscopic polyarteritis, 1
glomerulonephritis, RA, SLE, IBD,
PSS
SLE, SCLE, RA, Scleroderma,
Sjogren's, Dermatomyositis
SLE, recurrent thrombosis, antiphospholipid syndrome, recurrent
miscarriage
CREST, Scleroderma, Raynaud's,
PBC
Rheumatoid Arthritis
Coeliac disease, Dermatitis
Herpetiformis
SLE, AICAH
SLE, MCTD, Scleroderma,
Polymyositis
Bullous skin diseases
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Immunology tests performed at York Hospital
Test Name
Report/Reference range
Further tests if initial test positive
&/or relevant clinical details
Gastric Parietal Cell antibody
Negative or positive
Glomerular Basement Membrane
antibody
Intrinsic Factor Antibody
Liver Kidney Microsomal antibodies
Negative or positive (0 – 20Units/ml)
Intrinsic Factor antibody
when PA is suspected
ANA, C3, C4, ANCA, CRP
0 – 6 Units/ml
Negative or positive (titres)
Confirmation by immunoblot
Mitochondrial antibodies
Negative or positive (titres)
Anti-Myeloperoxidase antibody
Negative or Positive (0 – 5 Units/ml)
Anti-Proteinase 3 antibody
Negative or Positive (0 – 5 Units/ml)
Rheumatoid Factor IgM (RF)
0 – 18.5 U/ml
Anti-Citrullinated Protein Antibody
Smooth muscle antibodies
Negative or Tubular or Vascular
SMA
Negative or positive
AChR antibody
Striated muscle antibodies
ANA, CRP, Confirmation by
immunoblot
Clinical significance
Pernicious anaemia & antral gastritis
RPGN, Goodpasture's syndrome
Acquired pernicious anaemia
AIH Type II, drug induced hepatitis
PBC
Systemic vasculitides, RPGN, ChurgStrauss
Wegener's, microscopic polyangiitis,
Churg-Strauss
RA (seropositive) maybe present in
SLE, Scleroderma, Sjogren's, chronic
bacterial infections
CAH and AIH Type I
Myasthenia gravis, Thymoma
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Test Name
Acetylcholine Receptor Antibody
(anti-AChR)
Anti-GM1
Glutamic Acid Decarboxylase (AntiGAD)
Myelin Associated Glycoprotein (antiMAG)
Ovarian antibodies
Purkinje cell antibodies
(Anti Hu, Yo, Ri)
Sperm antibodies
Testicular antibodies
Voltage Gated Calcium Channel
antibodies (anti-VGCC)
Voltage Gated Potassium Channel
antibodies (anti-VGKC)
Anti MuSK
Anti-GQ1B
Anti-Basal Ganglia
Cardiac muscle antibodies
Pancreatic Islet Cell Antibody
Adrenal Antibody
Anti GD1b
Collagen Type II Antibody
Immunology tests referred to other laboratories
Further tests if initial test positive
Report/Reference range
&/or relevant clinical details
10
0-5 x 10 M
Negative or positive (titres)
<200 Negative, >200 Positive
Negative or positive (titres)
<1.0 U/ml
<1000 BTU
Negative or positive
Negative or positive (titres)
Negative 0-200
Neg (<50%) or Pos (>50%
agglutination)
Negative or positive
Negative or positive (titres) <45pM
Clinical significance
Myasthenia gravis/Thymoma
Chronic peripheral neuropathy
syndromes
Stiff-man syndrome, IDDM
IgM monoclonal neuropathy,
Waldenstrom's macroglobulinaemia
Primary ovarian failure or associated
with other autoimmune
endocrinopathies
Paraneoplastic cerebellar syndrome
and neuropathies
Infertility
Infertility
Amyotrophic Lateral Sclerosis (ALS)
Negative or Positive Titres (<100pm)
Acquired neuromyotonia
Negative or Positive
Negative or Positive (titres)
Negative 0-25
Negative or Positive
Negative or Positive
Negative or Positive
Negative or Positive
Negative or Positive
Negative or Positive
Myasthenia gravis
Miller-Fisher syndrome
Chorea, tics, dystonia
Dressler’s, post MI
IDDM
Addison’s Disease
Opthalmoplegia
Relapsing perichondritis
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Location and addresses of Referral Laboratories
TEST
Anti-AChR (Acetyl Choline Receptor Ab)
Anti-GAD (Glutamic Acid Decarboxylase Ab)
Anti-GM1 (Ganglioside Ab)
Anti-GQ1b (Ganglioside Ab)
Anti-GD1b (Ganglioside Ab)
Anti-MAG (Myelin Associated Glycoprotein)
Anti-VGCC (Voltage Gated Calcium Channel Ab)
Anti-VGKC (Voltage Gated Potassium Channel Ab)
Purkinje Cell Antibodies (‘Hu’, ‘Yo’ & ‘Ri’ & other paraneoplastic syndrome
associated antibodies)
MuSK
Anti-Sperm Antibodies
Anti-Gliadin Antibodies
Cardiac Muscle Antibody
Collagen Type II Antibody
Ovarian Antibodies
Anti-Histone Antibody
Pancreatic Islet cell Antibody
Adrenal Antibody
Anti-Basal Ganglia Antibody
REFERRAL LABORATORY
Neurosciences Group
Institute of Molecular Medicine
John Radcliffe Hospital
Headington
Oxford
OX3 9DS
Tel: 01865 222322
Sub-Fertility Laboratory
st
1 Floor, Old Building
St Mary’s Hospital
Hathersage Road
Manchester
M13 0JH
Department of Immunology
Northern General Hospital
P O Box 894
Sheffield
S5 7YT
Clinical Immunology
Old Medical School
Leeds General Infirmary
Thoresby Place
Leeds
LS2 9JT
NeuroImmunology and CSF Laboratory
The National Hospital for Neurology and Neurosurgery
Queen Square
LONDON WC1N 3BG
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MICROBIOLOGY DEPARTMENT
1.
2.
3.
4.
Routine investigations
Collection of specimens
Blood cultures
Surgical specimens
Dr D Hamilton (Clinical Lead)
Consultant Microbiologist
Telephone
(01904 72) 5672
Dr K Blackmore
Consultant Microbiologist
(01904 72) 6256
Dr N Todd
Consultant Microbiologist
(01904 72) 5216
Dr B Neish
Consultant Clinical Scientist
(01904 72) 4939
Ms D Cammish
Head BMS
(01904 72) 5704
Mrs F Walton
Operational Manager
(01904 72) 5065
Mr S Carr
Senior BMS, Serology section
(01904 72) 6301
Ms Durga Thapa
Senior BMS
(01904 72) 5721
Ms Julie-Anne Child
Senior BMS
(01904 72) 5721
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Microbiology Enquiries
Clinical advice
Monday to Friday 9 - 5
Ring 01904 725930 for clinical advice on GP patients
Ring 01904 725931 for clinical advice on hospital patients
All other times: Contact microbiology doctor on call via hospital switchboard
All other enquiries
5856 or 5857 (internal) or
01904 725856 or 725857 (external)
NORMAL WORKING HOURS
8.30 a.m. until 5.00 p.m. Monday to Saturday.
An on-call service is provided to cover URGENT SAMPLES ONLY at all other times.
However, there is a member of staff available on site 5pm until 8pm, Monday-Friday and 8.30a.m until 4.00pm Sunday.
They can be contacted via Switchboard for urgent work.
REQUESTS FOR URGENT ANALYSIS OUTSIDE NORMAL WORKING HOURS
1. The microbiology Laboratory operates an on call service for CSF samples plus pus from deep seated infection, and body fluids such as pleural or ascitic fluids
(but excluding urine). After midnight only CSF samples will be processed. Any other request for urgent work will require approval from the consultant
Microbiologist.
The Microbiology BMS on call MUST be contacted by the Switchboard Operator when ANY specimen requires urgent microbiological analysis out of
normal working hours.
It is the responsibility of the doctor initiating the request to ensure that all urgent and important samples are expected by the relevant Laboratory.
Example: For urgent cerebrospinal fluid analysis:
If a CSF sample requires analysis out of normal working hours, the Doctor initiating the request MUST contact the Microbiology BMS on call via the
switchboard (Dial 0). Additionally the Doctor MUST also inform the Chemical Pathology BMS via Bleep 934.
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2. Request for blood cultures out of normal working hours.
Blood cultures should be packaged inside the Safeshell carriers provided and dispatched to the laboratory by pneumatic tube.
MICROBIOLOGY REQUEST FORM
The generic test ‘culture and sensitivity’ has been removed from the Microbiology request form. For samples such as swabs, faeces and sputa the default test
is culture and sensitivity and will be done automatically. If you require a specialised test such as TB culture on a sputum sample then tick the TB culture
option on the request form.
ROUTINE INVESTIGATIONS
Specimens for routine investigations should be collected as early in the day as possible to ensure that they arrive in the laboratory during normal working hours.
TURN-ROUND TIME
Specimens received during working hours will be cultured that day. Negative urine reports are available the same day. Wound swabs, vaginal swabs, sputum
specimens and faeces take two working days before a negative result can be issued. Often, a positive result can take 4 working days to complete, but certain
fastidious or unusual isolates may take longer to identify. In these cases, interim results are often available, and can be obtained by telephoning the laboratory.
Blood culture broths showing no signs of growth are incubated for five days before being reported. Significant blood culture isolates are often telephoned through
by the clinical microbiologist on primary isolation.
Chlamydia NAATs tests are performed daily and final reports issued within 4 days of receipt of the sample in the laboratory.
Most in-house serology tests are carried out on a daily basis and reported within 48 hours Monday - Friday. Helicobacter pylori antibodies are batched and
processed at least weekly and reports issued within 10 days of receipt.
Tests referred to most Reference Laboratories have a turnaround time of 1 – 2 weeks: verbal reports are available in 3 - 4 days, or sooner by arrangement if
urgent. Hepatitis C and HIV results are available within 48 hours Monday – Friday.
Contact details and turnaround time information on all the Reference laboratories routinely used by York microbiology can be found by following the link below
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Ref Lab Table
Requesting further tests on samples already received in the laboratory
Blood samples for serology are kept for 2 weeks, antenatal samples for 2 years. Needlestick samples are kept indefinitely. We also keep a small number of
acute serum samples until a convalescent sample is received. If you want to add further tests to a blood sample we will require an additional request. Please
phone 01904 726301 to make arrangements
Most other samples are kept for at least 1 week before they are discarded.
Some samples are kept longer depending on the tests requested. If you want to add further tests to a sample please ring 01904 725721. We will check if we still
have the sample and then add the tests. Please note that in some cases the sample may be unsuitable and we will ask you to obtain a fresh sample.
RANGE OF INVESTIGATIONS
In addition to a comprehensive traditional bacteriology service we also carry out:
Investigation
Chickenpox antibodies
Chlamydia NAAT (nucleic acid amplification technology)
CMV IgM and IgG
Helicobacter pylori antigen
Hepatitis A IgM
Hepatitis B markers for infection
Hepatitis B surface antibody
Hepatitis C antibody
HIV antibodies
Lyme Disease IgM and IgG
Measles antibodies
Mycology – microscopy and culture for fungi
Mycoplasma antibodies
Rotavirus
RSV antigen
Sample type
Clotted blood
Urine or swab in lysis buffer (available from laboratory)
Clotted blood
Stool sample
Clotted blood
Clotted blood
Clotted blood
Clotted blood
Clotted blood
Clotted blood
Clotted blood
Skin and nails
Clotted blood
Stool sample
Naso-pharygeal aspirate
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Rubella IgG
Syphilis serology
Toxoplasma screen
Clotted blood
Clotted blood
Clotted blood
Other tests are referred to accredited reference laboratories for specialised serology or NAAT testing.
Collection of specimens
Urine
The method in use estimates the number of pus and other cells, and the number of bacteria in urine to help to distinguish infection from contamination.
A midstream urine or catheter specimen is sent to the laboratory in a sterile 30 mL boric acid container.
Urines should be examined within 1 - 2 hours of collection. If this is not possible then refrigeration at 4°C for up to 24 hours is possible for most specimens without
much change in bacterial count, but the white cells may become unrecognisable.
Red blood cells may lyse in dilute urine shortly after the specimen being taken: an on site “stick” test will give a more accurate indication of the presence of blood.
Suggestions for the collection of an MSU
Males
Retract the foreskin if necessary, and then pass the first part of the stream into the w.c. pan and catch the second part in the container.
Females
If there is a menstrual or vaginal discharge, use of a vaginal tampon is helpful. The patient should be instructed to swab the vulva from the front backwards using a
cotton-wool swab soaked in sterile water, whilst separating the labia with two fingers of one hand. Antiseptics must be avoided. Keeping the labia separate, the
patient passes the first part of the stream into the w.c. and catches the second part in a sterile container.
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Babies and young children
A clean-catch specimen is preferred because urine in adhesive bags is frequently contaminated. Special small volume boric acid containers are available for small
paediatric specimens.
Urine for TB culture
3 early morning 150 mL specimens are usually required. These may be delivered to the laboratory as collected or refrigerated each day and taken to the
laboratory together. The laboratory supplies suitable containers.
Schistosomes
For S. haematobium a complete collection of urine voided between 10am and 2pm is required. At least 3 such specimens should be examined. Serological tests
to exclude Schistosomiasis may be requested after 3 months from the last exposure.
Clotted blood samples for antibiotic assay
The following information must be written on the Microbiology request form for any samples sent for an antibiotic assay.
•
•
•
•
Dose regime (size of dose and frequency)
Time of last dose
Nature of sample i.e. pre dose/post dose/post single daily dose/pre dialysis aminoglycoside therapy
For single daily dose aminoglycoside therapy the time after the dose at which the blood was drawn must be provided
The most common assays are for gentamicin, tobramycin and vancomycin although others are occasionally done. If this information is missing the performance
of the test will be delayed until the information can be obtained, from the requester. If the information cannot be obtained then the requester will be asked to
repeat the test.
Responsibility for completing these requests lies with the medical staff responsible for the patient and the phlebotomists should not be asked to take these samples
Swabs for bacteriology
Place swab in tube containing transport medium, e.g. “Transwab”. Swabs that are not sent to the laboratory immediately can be stored at room temperature for up
to 24 hours.
For the diagnosis of Pertussis pernasal swabs are available and are preferred to cough plates. Swabs should arrive (by arrangement with the laboratory) within
half an hour of being taken, as the causative organism is particularly fastidious.
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Pus
A few mL of pus in a sterile 60mL universal bottle or a few drops in a capped syringe with the needle removed is much better than a swab.
Sputum
Use wide-necked pots with screw-on lids. For most purposes an uncontaminated early morning or post-physiotherapy specimen is preferred. Saliva is not
suitable.
Culture of non-purulent material is not helpful as mouth flora inevitably predominates. Inadequate specimens will be discarded. For M. tuberculosis and fungal
culture, at least three early morning specimens are required.
Lower respiratory tract specimens for Pneumocystis examination
Bronchoalveolar lavage specimens are best for identifying this organism. If this procedure cannot be carried out then sputum induction with nebulised hypertonic
saline can be helpful, although false negatives are common. This must only be done in a single-bedded room to prevent cross-infection.
Cerebrospinal Fluid (CSF)
IN ALL CASES - The microbiology department must be informed when a CSF has been taken.
DURING NORMAL WORKING HOURS: The Laboratory must be informed directly via extension 5721
AT ALL OTHER TIMES: The Microbiology BMS on call must be contacted via the switchboard (Dial 0)
It is the responsibility of the Doctor initiating the request to ensure that the CSF samples are expected by the Laboratory.
For routine investigation at least 5mL of CSF should be obtained. If extra investigations are required more CSF will be needed. The CSF should be divided into
three sequentially numbered sterile 28ml universal containers. These should be labelled “First”, “Second”, etc.
If a glucose level is required another bottle containing fluoride should also be sent together with a sample of blood taken at the same time in another
fluoride bottle and sent to the biochemistry department.
Extra tests can be arranged by discussion with medical microbiology staff.
These include:
Serological tests for Syphilis
PCR for Herpes group viruses, Enterovirus and mumps
Cryptococcal antigen
TB culture
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Testing Cerebrospinal Fluid (CSF) Samples for Creutzfeldt-Jakob Disease (CJD):
Testing CSF for
CJD.doc
Double click icon to open
Faeces
Use pots with a collecting spoon.
Suggestions for collection of faeces specimens:
When opening your bowels please use one of the following collection methods. It is of paramount importance NOT to scoop the specimen from the W.C. basin as
this will be contaminated and may lead to false results.
1. Pass the motion or part of the motion into a suitable container (e.g. clean margarine container or child’s potty.)
2. With the spoon attached to the lid scoop some of the motion into the specimen container. Do not fill more than half full.
For certain tests the container needs to be at least a quarter full.
Make sure the lid is securely fastened and the pot placed in the polythene bag provided.
3. On completion, empty the remaining faeces into the W.C and:a) Wrap the disposable container in a newspaper and place it in the dustbin or
b) Using hot soapy water thoroughly wash, rinse and dry the potty using disposable kitchen roll or similar.
4. Please ensure that the person’s identity is written clearly on the label of the specimen container.
Specimens for Enterobius (threadworm) investigation.
Normally the condition is diagnosed by microscopic detection of the nematode eggs sampled from the perianal area. However, in extremely heavy infestations
some worms may be seen on the buttocks and in the stools. Normally the eggs may be sampled by swabbing the perianal skin with a swab moistened with saline,
preferably first thing in the morning. The recommended method is to then dip, rotate and squeeze the swab in 3-5ml of sterile saline in a plain universal, The swab
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can then be discarded and the universal labelled and sent to the laboratory for centrifugation and microscopy. Alternatively, the sellotape slide method may be
used, which involves attaching a piece of sellotape over the perianal region overnight. The sellotape is removed and fixed, sticky side down and as smoothly as
possible on a glass microscope slide. The slide must be labelled and submitted in a slide carrier box for investigation.
Blood cultures (See attached document for best practice)
Blood Cultures
method.doc
Check the expiry date on both bottles. Discard any bottle that is within 14 days of expiry
1. Patient ID stickers should be attached to blood cultue vials, taking care, however, not to obscure the unique vial barcode.
2. Blood cultures should be taken when clinically indicated and not left for the phlebotomists.
If possible take cultures before starting antibiotics.
Culture the blood once or twice during each clinical episode (three times for endocarditis).
3. Up to 20 mL of blood can be cultured per two-bottle set: DO NOT INOCULATE MORE THAN ONE SET AT A TIME.
Bottles
1
Standard set with antibiotic removal devices
Blue cap
Aerobic
Gold cap
Anaerobic
Ideally 8-10ml per bottle, but not less than 5ml and no more than 10ml per bottle.
2.
Paediatric bottle single aerobic bottle for low-volume culture, i.e. not more than 5ml Pink cap ideally 1 – 3 mL
Taking the blood
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3. Use a 20 mL syringe and needle, not the "monovette" system.
Do not culture blood from lines, except when diagnosing line infection. In such cases peripheral venous blood should also be cultured.
4. Thoroughly disinfect the skin at the site of venepuncture with alcohol and preferably iodine.
If palpation of the vein is essential then also disinfect the probing finger or glove.
Bottle inoculation
5. Remove the "flip tops" of both bottles
6. Check that the broth is not cloudy, and that the rubber septum is not bulging.
7. Wet the bung with alcohol and allow to dry.
8. Inject 8 to 10 mL of blood into each bottle through the bung.
Do not allow the bottle to suck in more than this.
Inoculate the anaerobic bottle first to prevent any air getting in.
9. Write the patient's name or place an ID sticker on the bottles, taking care not to obscure the vial identification barcode, and send them to the laboratory
with a request card. These bottles should be sent in the pneumatic tube system using all the packaging supplied with the bottles.
The bottles must remain at room temperature prior to transport to the laboratory.
Do not refrigerate the vials, or warm them on radiators etc.
Surgical Specimens
SPECIMENS MUST NOT BE PUT IN FORMOL SALINE for microbiology. Use dry sterile containers, e.g. sputum pots. Make sure specimens are sent directly to
the laboratory and not refrigerated. The laboratory should be informed if the specimen is urgent or requires processing out of hours.
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Skin scrapings, hairs and nails for mycology
Use a sputum pot or a “dermapack” collection pack.
Chlamydia - Collection of samples
The laboratory issues collection kits for urine and swab samples. This contains a lysis buffer which should not come into contact with the skin, eyes, or mucus
membranes.
Female swab collection protocol for endocervical samples
Using one of the two swabs (provided), remove excess mucus from the cervical os and surrounding mucosa. Discard this swab after use.
• To collect the specimen, insert the second swab into the cervical canal & gently rotate the swab 5 times in one direction to ensure adequate sampling.
• Place the swab into the tube until the visible score mark is aligned with the tube rim & break the swab at this point; discard the top portion of the swab.
Handling precautions
• DO NOT pre-wet collection swabs with the collection media before obtaining the endocervical specimen.
• Use care to avoid splashing of contents.
Urine collection protocol
Patient should provide a first-catch urine (approximately 10 to 50 mL of the initial urine stream) into a sterile urine collection cup (not provided).
• Using the plastic pipette (provided), transfer the urine into the sample tube at a level within the two black lines indicated on the label. If transfer can not be done
immediately unstabilized urine may be held for up to 24 hours at 2-30˚C.
• Cap & invert the tube 5 times to mix
Handling precautions
• Female patients should not cleanse the labial area prior to providing specimens.
• DO NOT collect specimen from patients who are menstruating.
• Female and male patients should not have urinated for at least one hour prior to sampling.
• Use care to avoid splashing of contents.
Storage & transport to laboratory
Once in the transport medium the samples are stable at ambient temperature (2°C to 30°C) for up to 90 days.
Eye swabs. Swabs should be submitted in Chlamydia transport medium for PCR investigation.
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VIROLOGY
1. Transport of specimens
2. Use of the laboratory
3. Table of specimen requirements
Viral culture
Swabs: Special non-toxic wooden-shafted swabs should be broken off into the pink liquid provided (“bijoux” bottles with white label) and refrigerated. Fragile
viruses such as Herpes simplex will often be lost if delays more than twenty four hours occur before they are cultured - and we have to get them to Leeds.
Faeces: Collect in the standard faeces container. Clearly mark the request form for “viral culture”.
Urine: Add an equal volume of urine to urine transport medium (double strength) and send to the laboratory immediately.
Vesicle fluid: Due to safety considerations the laboratory will not accept vesicle fluids in syringes. If PCR or culture is required, the fluid may be collected in a fine
gauge needle and expressed into viral transport medium.
NOTE: ALWAYS SEND A SPECIMEN FOR VIRUS ISOLATION TO THE LABORATORY AS SOON AS POSSIBLE.
Clotted blood or serum for antibody studies
Paired sera are usually required, one in the acute and the second in the convalescent phase (10-14 days after onset). We need to know enough clinical detail to
decide which viruses to screen for, and a date of onset to decide whether waiting for a second serum is appropriate.
Only a limited range of viruses is tested for, and often serology is unhelpful, e.g. for coxsackie and echo viruses where culture or PCR of throat swab and faeces is
suitable. Viral serology is helpful when a specific virus is suspected (e.g. rubella, CMV, mumps), or with particular problems such as rash, flu-like, and other
respiratory tract infections. Patients with vague or long-standing problems (“lassitude” etc.) almost never produce diagnostic results. As a high proportion of
people have antibody to Herpes simplex virus antibody tests are usually unhelpful: PCR is the diagnostic method of choice.
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TRANSPORT OF SPECIMENS
All fluids, e.g. CSF, pleural fluid, joint fluids and pus require culturing without delay. Specimens should preferably be taken during laboratory opening hours and
sent immediately to the Department. The Microbiology Department (NOT general pathology reception) should be warned of the arrival of urgent and important,
unrepeatable specimens. If taken outside laboratory hours the Microbiology “BMS on-call” should be contacted via Switchboard.
In general all specimens should reach the laboratory as soon as possible after being taken. Micro-organisms may be susceptible to drying, heat or cold
(particularly freezing). In specimens such as sputum and urine they can multiply to inappropriate levels.
Genital pathogens and anaerobic organisms are particularly sensitive to delays before culturing
All bacterial swabs should be placed in transport medium (the clear jelly seen in many swab tubes) which prevents drying, maintains pH and excludes oxygen;
Swabs should be kept at room temperature until delivery to the laboratory.
Urine for culture should always be taken in the borate containing red-topped 30ml bottles to prevent bacterial overgrowth. Refrigerate until delivery.
Specimens of clotted blood (brown top “serum” tubes) are suitable for all serological tests. Refrigerate until delivery: do NOT freeze.
Blood cultures - Keep at room temperature and send the broths to the laboratory. Do not place on radiators etc as they get too hot (many pathogens cannot
tolerate temperatures over 37°C).
USE OF THE LABORATORY
In these days of clinical budgeting everyone is encouraged to use the laboratory in a cost-effective manner.
The microbiology laboratory can help to:
•
•
•
provide or confirm a diagnosis
suggest appropriate antibiotics
monitor response to treatment
Inevitably judgements will have to be made about whether to treat blind or request an investigation which may cost more than a course of antibiotics.
Failure to investigate may lead to:
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•
An increased use of antibiotics causing possible harm to patients
•
An increasing reliance on expensive new broad spectrum agents
•
Increasing antibiotic resistance in the community (and concomitant lack of knowledge of this)
•
Difficulty in establishing a diagnosis when a patient has failed to respond to treatment
LABORATORY METHODS
Microbiology assesses the clinical relevance of investigations performed and the reliability of interpretative comments in consultation with its users through user
surveys and general feedback.
New tests/services may be commissioned through discussions with the Clinical Microbiologists.
Methodology and testing is benchmarked against the Health Protection Agency (HPA) national standard operating procedures, whose web-site offers valuable
information on microbiological disease processes and associated microbiological investigations. http://www.hpa-standardmethods.org.uk/pdf_sops.asp
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Blood
SPECIMEN
INVESTIGATION
Serological investigations
Blood
Blood
CSF
Ear Swabs
Faeces
Faeces
Fluids
Genital swabs
Genital swabs
IUCD
Pernasal swabs
Respiratory swabs
Skin swabs
Skin, nails, hair
Hep C &HIV by PCR
Blood Culture
Culture & Sensitivity
Culture & Sensitivity
Culture & Sensitivity
Ova, cysts and parasites
Culture & Sensitivity
Culture & Sensitivity
Chlamydia
Culture & Sensitivity
Bordatella pertussis
Culture & Sensitivity
Culture & Sensitivity
Mycology
Sputum
Sputum
Swabs
Tissue
Urine
Urine
Urine
Urine
Wound swabs
Culture & Sensitivity
TB culture
Virology
Culture & Sensitivity
Culture & Sensitivity
TB culture
Schistosome ova
Virology
Culture & Sensitivity
SPECIMEN
Brown topped Sarstedt tube – 7.5mL clotted blood
is sufficient for several tests
Phone laboratory for advice
Blood culture sets available from laboratory
Universal container (white top)
Transwab (orange top)
Universal with spoon
Universal with spoon
60mL container
Transwab (blue cap)
Kit available from laboratory
60mL container
Pernasal swab available from laboratory
Transwab (blue cap)
Transwab (blue cap)
Folded in dermapak, or submitted in 60mL
container
60mL container
60mL container
Viral Transport medium – available on request
60mL container – must NOT contain formalin
30mL universal with boric acid (red top)
160mL container
160mL container
60mL container
Transwab (blue top)
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INFECTION CONTROL TEAM
Extension
6256
Bleep/Pager
Contact via
switchboard
Senior Infection Prevention Nurse Specialist
1346
809
Mrs V Parkin
Deputy DIPC
5304
Mrs Jane Balderson
Audit/Surveillance Nurse
5775
Dr K Blackmore
Trust Infection Control Office
Consultant Microbiologist
Linda Horton-Fawkes
Community Infection Prevention
01423 557340/347
The Infection Control Team has primary responsibility for and reports to the Chief Executive (via the Infection Control Committee) on all aspects of surveillance,
prevention and control of infection within the Trust.
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HISTOPATHOLOGY DEPARTMENT
1.
2.
3.
4.
5.
6.
7.
Histology
Cytology
Fixatives and specimen containers
Autopsy examination
Coroner’s autopsy examination
Death certificates
Cremation certificates
Dr A C Andrew
Consultant Pathologist
Telephone
(01904 72) 5801
Dr C Bratten
(01904 72) 5675
Consultant Pathologist and Lead Clinician in Histopathology
Dr AMT Clarke
(01904 72) 5669
Consultant Pathologist and Lead Clinician in Cytopathology
Dr I M Hanson
Consultant Pathologist
(01904 72) 6284
Dr PR Maheswaran
Consultant Pathologist
(01904 72) 5784
Dr N Maughan
Consultant Pathologist
(01904 72) 5474
Dr K Miller
Consultant Pathologist
(01904 72) 5477
Dr M Toy
Consultant Pathologist
Mr Trevor Hair
Head BMS
(01904 72) 4050
(01904 72) 5853/5783
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Helen Armitage
Operational manager
(01904) 725783
Office/Enquiries
(01904 72) 5774/5787
Histology Secretaries
(01904 72) 5772/5773/5776
Laboratory Enquiries (Histology)
(01904 72) 5728
Laboratory Enquiries (Cytology)
(01904 72) 6332
Mortuary
(01904 72) 6803
Mr K Breheney
Mortuary Manager
(01904 72) 6803
HISTOLOGY
The Histopathology Department is open from 8:30-5pm Mon-Fri. For information regarding verbal requests of reports, progress of cases, clinical advice, or
interpretation of results, please ring the Histology Office on 01904 72(5772/3/6). For any other information please ring the Histology Laboratory on 01904
72(5728).
For information regarding names and addresses of referral laboratories please contact the Histology Laboratory on the above number.
Request Forms
All specimens must be accompanied by a request form. All details on the request forms should be completed together with results of relevant investigations in
order to provide an adequate clinical history. Any therapy which may alter histological appearances should also be detailed on the request form.
Specimen Labels
Specimen labels must indicate the name of the patient, the ward, the nature of specimen and other relevant information. The laboratory cannot take
responsibility for unlabelled specimens.
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Specimen Transport
Specimens should be sent to the department as soon as practicable after removal. Medium and small sized specimens should be put in containers of
appropriate size containing a suitable volume of fixative (ideally some ten times more than the volume of specimen) which are obtainable from the Pathology
Department. All small biopsies (e.g. endoscopic, needle biopsies) should be placed in the biopsy capsules provided. The number of endoscopic biopsies should
ideally be stated on the request form. Biopsy capsules for this purpose are available in the endoscopy suite and at various sites around the hospital where small
biopsies are commonly taken. Please contact the department for advice where any doubt exists. Fresh specimens from theatres must be double bagged, with a
patient identification label attached to the inner bag. Place the Histology request form in another clear bag and place both the specimen and the request form in
to another bag and knot it. These specimens are kept in the theatres’ fridges prior to collection by the porters.
All fresh specimens should be delivered to the Microbiology department in the theatre tins provided. Care must be taken in the transportation of all such
specimens and they must be handled as potentially infectious.
Disposal of Specimens
Unless the department is advised otherwise, all specimens are disposed of five weeks post-receipt.
Frozen Sections
These should be requested by telephoning the Histology Laboratory at least 24 hours in advance. The specimen should be received fresh and delivered directly
to the laboratory. The procedure takes about 15 minutes from receipt of the specimen to the telephoned report. If several frozen sections are required (e.g. for
the exclusion of malignancy in lymph nodes), each separate specimen will take a further 10 to 15 minutes. The extension number to which the report should be
telephoned MUST be clearly stated on the request form to prevent any delay.
Lymph Nodes
Lymph nodes removed for suspected lymphoma should be sent to the laboratory immediately in a fresh unfixed state. The laboratory must be informed that a
specimen is to be taken to ensure staff are available to deal with the specimen immediately. Out of hours these specimens should be refrigerated.
Skin biopsies for Immunofluorescence
Notice is required for immunofluorescence. The specimen should arrive in a Petri dish, moistened with saline. If it is sent from another hospital it should be
placed in Zeus tissue fixative.
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Skin Biopsies for Marker Studies
Notice is required for marker studies. The specimen should arrive in a petri dish, moistened with saline.
Renal biopsies
Notice is required to allow the laboratory time to make up the Mirsky’s Fixative. When booking the specimen the following details are required: Patient name,
DOB, Hospital number, Consultant, Date and time of biopsy, degree of urgency, and details as to whether it is a native or transplant biopsy. The renal biopsies
should be placed in the appropriate fixatives according to the clinical details: (i) 10% Formal Saline (ii) Mirsky’s fixative is required for the EM specimen (iii) Zeus
tissue fixative for immunofluorescent studies. The specimens should be sent immediately. Specimens that are received into the Histopathology Department at St
James's Hospital, Leeds after 12:30pm will not receive a same day diagnosis. Urgent specimens need to arrive in the Histology department no later than
11:15am to be dealt with the same day. The requesting doctor must ring St James's Hospital, Leeds to inform them of any urgent renal biopsies on 0113
20677498 or 0113 2067530.
Testicular biopsies
Notice is required. Bouin’s fixative will be provided. The specimen should be sent immediately.
Muscle biopsies
These specimens require advance notification on 0113 3927880 or 0113 3927830. They should be sent by taxi directly to Britannia House, Britannia Road,
Morley, Leeds, LS27 0DQ. The muscle biopsy should be wrapped in saline moistened gauze and placed in a sterile specimen pot and labelled appropriately.
Placenta Specimens
These specimens should be placed in the clear plastic bags provided by main theatres (swab bags). Please do not use the bags labelled ‘pathology specimens’
as they are prone to leak. The placenta must be placed in one bag and the top of the bag knotted. A patient identification label must be placed on this bag.
Place the Histology request form in another clear bag and place both the placenta and the request form in to another bag and knot it. During working hours the
bagged placenta is then placed in a white bucket and sent to the laboratory via a porter (buckets are obtained from the Histology department). Out of hours the
specimen is refrigerated and sent as above the following day. If the placenta is too large to fit in to a bag it is placed directly in to the bucket with the lid securely
placed on top. The patient identification label is placed on the outside of the bucket and the bagged request form is securely attached to the bucket lid.
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Cytogenetics
Specimens should be sent directly to the Histopathology Department in the appropriate transport medium, accompanied by a Cytogenetics request form. The
transport medium is provided by the Cytogenetics Department at St. James’s Hospital where the test is performed.
Urgent specimens
Please indicate the urgency of the specimen on the request form and the date by which a report is required. Please confirm these arrangements by telephone.
Out of hours requests
Frozen sections are only carried out in extreme emergencies. A Consultant Histopathologist can be contacted via the switchboard.
CYTOLOGY
Cervical Cytology
Specimens are transported to the laboratory in the dedicated NYCSS transport bags sealed with a plastic security tag.
All requests for cervical cytology should be accompanied by the special (HMR 101/5) forms and all details must be completed with the full patient address, NHS
number, and sender details along with the smear takers unique LBC smear taker code. Information for smear takers and smear taker codes are available
through the Cervical Sample Taker Database http://www.cstd.neyhqarc.nhs.uk/admin/. Correct patient details enables correct matching via links with the FHSA
computerised recall system.
Liquid based cytology ‘clinic kits’ are available from the laboratory. Forms to order LBC clinic kits are available from Pathology Reception, as part of the
Laboratory Medicine Pathology order form
LM-TEM-GENORDFR
M.doc
or the NYCCSS order form for these kits only.
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"NYCCSS order
form.doc"
These kits contain all of the necessary consumables to take 25 LBC cervical samples. LBC endocervical samplers are not provided by the laboratory but may be
purchased from Medical Solutions if deemed necessary by the Gynaecologist.
GP practices must purchase their own stock of Rover cervex brooms should they require additional stock.
Reporting of cervical cytology is in accordance with national guidelines. The 14 day turnaround is measured from the date the sample is taken to the date the
lady receives her result letter. Therefore it is imperative that all cervical samples are dispatched to the laboratory on the next available transport.
If you require further information please contact the laboratory for details.
The laboratory has implemented HPV testing for high risk types as triage and test of cure in accordance with national guidelines.
A negative result does not preclude the presence of HPV infection because results depend on adequate
specimen collection, absence of inhibitors (e.g. vaginal lubricants, heavily blood stained samples), and sufficient DNA to be detected.
Limitations of HPV testing:
Non-gynaecological Cytology
Fine needle aspiration cytology
Cell samples taken by aspiration from solid lumps should be spread thinly onto glass slides and air-dried by waving the slides vigorously in the air, particularly if
there is a lot of blood contamination. Afterwards the needle and syringe should be rinsed in the needle washing fluid which should also be sent together with the
glass slides for examination. The laboratory provides an immediate reporting service for FNA samples if required. The doctor requiring the service should phone
extension 6332 to request immediate reporting and this should be agreed with the reporting Cytopathologist. They should send the sample to the laboratory
immediately. The request form must clearly state where the report should be sent and the telephone extension number highlighted.
Serous and Cyst Fluids
A fresh representative specimen should be sent to the laboratory in a 25mL white-topped Universal container. These should reach the laboratory as soon as
possible, but if they are taken at the weekend or out of hours they can be refrigerated.
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Seminal fluids/Sperm samples for infertility and post vasectomy analysis
Infertility investigation:
Patients please note: You will need to be provided with a pre-weighed and toxicity tested pot by your GP for your sperm sample, along with a request form
signed by your clinician before we can accept your sample for analysis.
Any samples received which are not in a pre-weighed and toxicity tested pot with a signed request form will unfortunately be unsuitable for analysis and will
be rejected. The sample pot must have your name and date of birth on it.
Samples for fertility investigation i.e. for sperm morphological assessment, count and motility, should be brought directly to York Teaching Hospital, Laboratory
Medicine, Specimen Reception between 8.45am and 3pm Mon-Fri, ideally within 1 hour of production in the toxicity tested sample pot provided by your
GP/Clinican. It is important that the time of collection should be clearly indicated on both the form and specimen pot as samples which are examined more than
two hours from production are unsuitable for assessing sperm motility.
Directions: On arrival at the York Teaching Hospital Main Entrance, turn immediately right past the Patient Discharge Lounge, then right at the T junction,
Sample Reception is 10m down on the left.
Please do NOT bring infertility samples to Scarborough Hospital laboratories as these samples are time sensitive and cannot be analysed at the Scarborough
laboratory.
In exceptional circumstances a patient facility can be made available for the production of a sperm sample on-site by prior arrangement only with the
laboratory only, please telephone 01904 726332 to make an appointment.
th
Normal Ranges: Taken from WHO Laboratory Manual for the examination of Human Semen and Sperm-Cervical Mucus Interaction 5 Edition 2010
Sub fertile range:
Count <15 million sperm/ml.
Motility <40%
Morphology <4 % normal forms
Lower reference limit for semen volume is 1.5 ml.
Post Vasectomy samples:
These samples are not time sensitive and do not require a pre weighed pot, a normal sterile sample pot supplied by your GP will be adequate. These can be
taken either back to your GP or to either York or Scarborough Laboratory Medicine reception.
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Post vasectomy samples for analysis should be brought to the laboratory on the same day as production, 3 months after surgery.
Sputum
Sputum samples should only be sent for cytology if there is a reasonable suspicion of malignancy in patients who are unsuitable for bronchoscopy. In most
cases the respiratory pathology is due to infection which resolves on treatment. Sputum should only be sent if the clinical symptoms and radiological findings do
not resolve after a course of treatment. The pick-up rate for malignant cells is very low because of inappropriate patient selection. Examination of sputum
samples is an expensive and time-consuming process.
Early morning specimens of sputum on three consecutive days are desirable, and these should be obtained before eating and oral hygiene have been
commenced. The specimen should be a deep cough specimen and sent straight to the laboratory.
Urine
A fresh sample of urine (not the first early morning specimen) is required, some 30mL being sufficient. The specimen should reach the laboratory as soon as
possible.
Samples referred to other laboratories
Any non-gynaecological samples with appropriate clinical information may require haematological investigations which are not available at York
Hospital.
These specimens will be received fresh into the York cytology laboratory and are transported to HMDS Leeds Teaching Hospitals NHS Trust. without undue
delay (i.e. the same day). If a sample only requires investigations to be undertaken at HMDS they should be sent to the Haematology laboratory who
will forward the specimen.
The final report will be sent to the requesting clinician and a copy sent to our requesting pathologist. The turnaround times from HMDS are routinely 1.6 days for
CSF samples and 3.2 days for tissue aspirates and effusions.
Turn Round Times for Reports
The following times given are the minimum time taken to process and produce a typed report. Inquiries regarding reports should not be made in advance of the
minimum time. If an urgent report is required, this should be clearly indicated on the request form. A telephone or bleep number should be given.
Surgical Histology Specimens:
Non-gynaecological Cytology:
3 days from receipt
70% are reported within 3 days from receipt
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(FNA rapid verbal reporting 30 mins from receipt after agreement with the reporting pathologist)
Gynaecological Cytology:
7 days from receipt (urgent), 14 days routine.
FIXATIVES AND SPECIMEN CONTAINERS
When used accordance with the safety data sheets provided, and in conjunction with the appropriate use of Personal Protective Equipment, the fixatives outlined
below present a low risk to staff. In the unlikely event of any formalin spillages within normal working hours please contact the histology laboratory on 5728.
Outside normal working hours spillages should be absorbed with inert, damp non-combustible material, then flush the area with water. Absorb small quantities
with paper towels and evaporate in a safe place. Allow sufficient time for vapours to completely clear, and then place the paper towels in a clinical waste bag
away from combustible material.
Storage
Formalin pots and buckets should be stored at room temperature in a dry well ventilated area. Keep containers securely closed.
Disposal
Out of date formalin pots should be returned to the laboratory for disposal.
Health and Safety
Formalin is harmful by inhalation, in contact with skin and if swallowed. May cause sensitisation by skin contact. Use protective gloves, and wear eye protection
when handling formalin.
First Aid Measures
EYES Wash eyes immediately with plenty of water whilst lifting eyelids. Seek medical attention immediately. Continue to rinse.
SKIN Remove affected person from source of contamination and immediately flush contaminated skin with plenty of water. If clothing soaked through, remove
it immediately and flush skin with water. Should irritation persist seek medical attention immediately
INGESTION Never make an unconscious person vomit or drink fluid. Let affected person drink lots of water immediately in order to dilute the swallowed liquid.
After the liquid has swallowed try to induce vomiting.
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INHALATION Move the exposed person to fresh air immediately. If breathing has stopped, perform artificial respiration immediately. Keep the affected person
warm and at rest whilst seeking medical attention.
1) Routine Histology specimens: Containers of 10% buffered formalin should be used.
Containers of various sizes are available from the laboratory.
2) Immunofluorescence: Petri dishes and containers of Zeus tissue fixative should be used.
3) Electron microscopy: Containers of Mirsky’s Fixative containers should be used.
4) Testicular biopsies: Containers of Bouin’s Fixative should be used.
Biopsy capsules should be used for the secure transport of small biopsies.
Cork boards are available for pinning out specimens prior to fixation.
Cytology consumables available from the Laboratory:
1. Containers
Type of container
60mL sterile container
25mL white-topped Universal container
Used for
seminal fluid/sputum
ascitic fluid
pleural fluid
cyst fluid
urine
1. Other consumables
Plastic specimen bags
Single frosted-end slides
LBC smear taking kits
Containers of needles
Slide carriers
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washing fluid for FNAs
AUTOPSY EXAMINATION
Both hospital and Coroners autopsy examinations are performed during weekdays only. An Autopsy may only be arranged out of hours in exceptional
circumstances (e.g. where there is requirement to remove tissue immediately). This will only occur with the specific agreement of a Consultant Histopathologist.
Mortuary Opening Hours
08.30 – 16:30 hours Monday to Friday
Telephone Extension 6803.
The Mortuary technicians also initiate the cremation certificate procedure.
On weekends, Bank Holidays and at all other times, the Mortuary Technician may be contacted via the Hospital Switchboard.
Mortuary Staff arrange viewing, initiate the Cremation Certificate procedure and liase with the Consultant on call for urgent autopsies.
Hospital Autopsy Examinations, i.e. Non-Coroner's Cases
It is imperative that an Autopsy Consent Form is completed and signed in all hospital request cases, even if verbal permission has been obtained. An Autopsy
Request Form stating the points of clinical interest, and the likely cause of death should also be completed. It is normal to issue a death certificate with the
appropriate box ticked “Information from post mortem may be available later”. If the cause of the death is obscure, the death should be reported to the Coroner.
Please inform the Mortuary Technician as soon as permission for autopsy has been obtained - do not rely on the autopsy request reaching the Mortuary, for
there may well be a delay. Send the consent and autopsy request forms plus the case notes and X-rays to the Mortuary promptly.
Perinatal and Foetal Examinations
All foetuses of any age should be sent to the mortuary with an appropriate request form completed. It is also helpful to contact the Mortuary directly if an
examination has been requested, especially if the birth has been out of normal working hours.
A completed consent form is required in all cases regardless of gestation.
Coroner's Autopsy Examinations
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Coroner’s Officers Location
Time
09:00-12:30
12:30-16:00
16:00-09:00
(Weekdays) and during
weekends
Location
Police Station
Mortuary, York Hospital
Via Control Room York
Police
Contact Number
01904 669332
01904 726804
01904 631321
Pamphlets on which cases to refer to the Coroner are available on the wards, but if in any doubt you are advised to contact your Consultant or one of the
Coroner's Officers. The Consultant Pathologist will also give advice.
The following is a guide to which deaths should be reported. Remember failure to report, or delay, may cause the bereaved relative unnecessary distress.
A death should be reported to H. M. coroner if:1. it cannot be certified as being due to natural causes.
2. the deceased was not seen by a doctor within the last 14 days.
3. there is any element of suspicious circumstances.
4. there is any history of violence.
5. the death may be linked to an accident (whenever it occurred).
6. there is any question of self neglect or neglect by others.
7. the death has occurred or the illness arisen during or shortly after detention in police or prison custody (including voluntary attendance at a police station).
8. the deceased was detained under the Mental Health Act.
9. the death is linked with an abortion.
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10. the death may have been contributed to by the actions of the deceased himself (e.g. self injury, history of drug addition or solvent abuse).
11. the deceased was receiving any form of war pension or industrial disability pension unless the death can shown to be wholly unconnected.
12. the death could be due in any way to the deceased’s employment.
13. the death occurred within 24 hours of admission to hospital.
14. the death occurred during an operation or before full recovery from the effects of the anaesthetic or was in any way related to the anaesthetic (in any event a
death within 14 days of surgery should normally be referred).
15. the death may be related to a medical procedure for treatment whether invasive or not.
16. the death may be due to lack of medical care.
17. there are any other disturbing features to the case.
18. it may be wise to report any death where there is an allegation of medical mismanagement.
DEATH CERTIFICATES
Remember you should not defer completing a death certificate until after the result of a hospital autopsy examination. You should put down your opinion as to
the cause of death and initial the section, 'Further information available later'. Avoid using vague terminology on the death certificate such as 'heart failure'
without qualification and also such terms as 'cerebrovascular accident or incident'. The word 'accident' or 'incident' should be avoided by the use of the term
'spontaneous intra-cerebral haemorrhage', 'cerebral infarction/cerebral thrombosis', 'subarachnoid haemorrhage' etc where appropriate. A death certificate
should not be issued in the case of Coroner's post mortem examinations - the Coroner will issue a disposal certificate. In all cases consideration should be given
to the bereaved relatives and documentation be completed as soon after death as possible to facilitate burial or cremation. If you are going off for a day or a
weekend please ensure that you inform the colleague who is covering for you.
Viewing of Bodies by Relatives of the Deceased
Relatives wishing to view deceased persons need every assistance, and arrangements should be made with the Mortuary Staff.
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CREMATION CERTIFICATES
The Mortuary staff initiates these and when Form '4' has been completed it should be sent, with the case notes, to the Mortuary, where arrangements will be
made for form '5' to be completed.
Extreme care must be exercised in completing medical certificates for cremation. These certificates are statutory and if they are not completed properly, fully
and accurately cremation may have to be postponed with resultant distress to relatives. All questions must be answered and abbreviations should not be used.
Form '5', the confirmatory medical certificate, may only be signed by a registered medical practitioner who has been fully registered with the General Medical
Council for not less than five years. A doctor who is on the same clinical team as the doctor who signed Form '4' should not issue this certificate. Both
certificates are examined by the Medical Referee who must be satisfied in all respects before the cremation is authorised. Owing to the risk of explosion or
radiation, bodies with cardiac pacemakers and/or radioactive implants in situ are not suitable for cremation. Pacemakers and implants must, therefore, be
removed and this fact stated on cremation forms. Arrangements for the removal of a pacemaker or implant should be made with a Consultant Histopathologist.
Where the deceased died as an in-patient in a hospital, and a post mortem examination has been made by a suitably qualified doctor, and the deceased's
medical attendant knows the result of the examination before giving his certificate, the cremation may take place without subsequent completion of Form '5'.
Question 10 on Form '4' covers this eventuality.
Signing of Cremation Form '5'
The Home Office takes the view that the term 'registered medical practitioner of not less than five years standing' means one who has been registered with the
General Medical Council for not less than five years; and in these circumstances registration outside the country would not count towards the requisite period. It
is also the view of the Home Office that any periods of limited or provisional registration cannot count as part of the five years. This means that the date from
which the five years is calculated is the date of registration with the General Medical Council, not the date of qualification.
The Medical Referee at York Crematorium has no option but to abide by the advice of the Home Office, and you should bear the above points in mind when the
question of signing cremation Form '5' arises.
Enquiries about the medical aspect of cremation should be addressed to the Medical Referee (District Medical Officer), City of York Crematorium, at Bootham
Park (York 642171 Ext. 77) or to the Superintendent, York City Crematorium (York 706096).
Doctors should note that crematorium fees are taxable and should be disclosed.
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